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1.
Arch. argent. pediatr ; 119(5): e480-e486, oct. 2021. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1292126

ABSTRACT

El bajo peso al nacer (BP, < 2500 g), la restricción del crecimiento intrauterino (RCIU) y el parto prematuro (PP, < 37 semanas de gestación) son los factores clínicos más habituales para la programación alterada del número de nefronas y se asocian con un mayor riesgo de hipertensión, proteinuria y enfermedad renal futura en la vida. En la actualidad la evaluación indirecta del número total de nefronas mediante el uso de marcadores en el período posnatal representa el enfoque principal para evaluar el riesgo de evolución futura de los trastornos renales en los recién nacidos con BP, RCIU o PP.Se presentan los avances en la investigación en animales y sobre marcadores bioquímicos en humanos, y recomendaciones para la prevención del daño renal preconcepcional, incluidos los factores sociales y las enfermedades crónicas. La evidencia demuestra que la restricción de crecimiento y la prematuridad solas son capaces de modular la nefrogénesis y la función renal y, cuando son concurrentes, sus efectos tienden a ser acumulativos.


A low birth weight (LBW, < 2500 g), intrauterine growth restriction (IUGR), and preterm birth (PB, < 37 weeks of gestational age) are the most common clinical factors for an altered programming of nephron number and are associated with a greater risk for hypertension, proteinuria, and kidney disease later in life. At present, an indirect assessment of total nephron number based on postnatal markers is the most important approach to evaluate the risk for future kidney disorders in newborn infants with a LBW, IUGR or PB.Here we describe advances made in animal experiments and biochemical markers in humans, and the recommendations for the prevention of preconception kidney injury, including social factors and chronic diseases. According to the evidence, IUGR and prematurity alone can modulate nephrogenesis and kidney function, and, if occurring simultaneously, their effects tend to be cumulative.


Subject(s)
Humans , Animals , Female , Pregnancy , Infant, Newborn , Adult , Premature Birth , Kidney Diseases/etiology , Kidney Diseases/epidemiology , Infant, Low Birth Weight , Gestational Age , Kidney , Nephrons
2.
Rev. Assoc. Med. Bras. (1992) ; 66(9): 1258-1263, Sept. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136369

ABSTRACT

SUMMARY INTRODUCTION: This study aims to determine the incidence of de novo nephritic syndrome (NS) in COVID-19 patients and identify its associated factors. METHODS: All ward patients with COVID-19 pneumonia were investigated. After determining the inclusion and exclusion criteria, the study population was identified. The urine dipstick test and urine protein creatinine ratio (UPCR) measurements were performed. Patients with de novo NS findings, nasopharyngeal swab, and urine RT-PCR tests were performed simultaneously RESULTS: This descriptive cross-sectional study was conducted with 21 patients with COVID-19. The mean age of the patients was 42.2±8.8 years, and 71.4% of them were male. The mean duration of follow-up was 28.4±9.3 days. The urine RT-PCR test was positive in one patient (4.8%). Improvements were observed in hematuria by 71.4%, and proteinuria by 85.7% at the end of the follow-up. A significant decrease in the measured UPCR was found in comparison to the baseline(P=0.000). Also, improvements were recorded in the complete blood counts, inflammatory parameters, ferritin, and coagulation tests, compared to the baseline. There was a positive correlation between baseline UPCR and ferritin, and a negative correlation between baseline UPCR and sodium values CONCLUSION: COVID-19-induced de novo nephritic syndrome may occur mainly due to tubulointerstitial involvement and often results in spontaneous remission. However, why these findings were not present in all patients who had no comorbidities is not clear.


RESUMO INTRODUÇÃO: Este estudo tem como objetivo determinar a incidência da síndrome nefrítica de novo (SN) em pacientes com COVID-19 e identificar os fatores associados. MÉTODOS: Todos os pacientes da enfermaria com pneumonia por COVID-19 foram investigados. Após a determinação dos critérios de inclusão e exclusão, a população do estudo foi identificada. Foram realizadas medições do teste da vareta da urina e da razão da creatinina das proteínas na urina (UPCR). RESULTADOS: Este estudo transversal descritivo foi realizado com 21 pacientes com COVID-19. A idade média dos pacientes foi de 42,2±8,8 anos e 71,4% dos pacientes eram do sexo masculino. A duração média do seguimento foi de 28,4±9,3 dias. O teste de RT-PCR na urina foi positivo em um paciente (4,8%). Houve melhorias observadas na hematúria em 71,4% e na proteinúria em 85,7% no final do acompanhamento. E uma diminuição significativa na UPCR medida em comparação à linha de base (p=0,000). Além disso, foram registradas melhorias nas contagens sanguíneas completas, nos parâmetros inflamatórios, nos testes de ferritina e de coagulação, comparados aos valores basais. Houve correlação positiva entre UPCR basal e ferritina, e correlação negativa entre os valores basais de UPCR e sódio. CONCLUSÃO: A síndrome nefrítica de novo induzida por COVID-19 pode ocorrer principalmente devido ao envolvimento túbulo-intersticial e frequentemente resulta em remissão espontânea. No entanto, a questão de por que esses achados não se apresentaram em todos os pacientes que não apresentavam condição comórbida não é clara.


Subject(s)
Humans , Male , Female , Adult , Pneumonia, Viral/complications , Coronavirus Infections/complications , Pandemics , Betacoronavirus , Kidney Diseases/etiology , Cross-Sectional Studies , Coronavirus Infections , Creatinine , Middle Aged
3.
Rev. inf. cient ; 99(4): 331-339, jul.-ago. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1139193

ABSTRACT

RESUMEN Introducción: El daño renal agudo es una complicación frecuente en las Unidades de Terapia Intensiva, sobre todo en pacientes con ventilación mecánica. Objetivo: Caracterizar el daño renal agudo en los pacientes tratados con ventilación mecánica invasiva en la Unidad de Terapia Intensiva del Hospital General Docente "Dr. Agostinho Neto" durante el periodo 2108-2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, que se aprobó por el Comité de Ética. El universo de estudio se constituyó por el total de pacientes con este diagnóstico según la clasificación Acute Kidney Injury Network (AKIN). Se estudiaron las características de los pacientes (necesidad y duración de la VAM, necesidad de hemodiálisis, estado al egreso) y del daño renal agudo (estadio y etiología). Resultados: El 47,5 % de los pacientes tratados con este soporte vital presentó un daño renal agudo, sobre todo los que la demandaron por siete o más días (68,4 %). El riesgo de muerte fue superior en los pacientes que requirieron ventilación mecánica o hemodiálisis. En los pacientes con daño renal estadio 2 y 3 de la clasificación que se utilizó presentaron un riesgo tres veces o más superior comparado con los que no necesitaron estas terapias. La sepsis (69,4 %) fue la principal causa del daño renal agudo. Conclusiones: El uso de ventilación mecánica invasiva y la presentación de un daño renal agudo son condiciones con una fuerte asociación, juntas y separadas se correlacionan con la mortalidad.


ABSTRACT Introduction: Acute kidney injury is a very common complication in the intensive care units, especially in patients with invasive mechanical ventilation. Objective: To characterize acute kidney damage in patients with invasive mechanical ventilation in the intensive care unit at the General Teaching Hospital ¨Dr. Agostinho Neto¨ within the period 2018-2019. Method: A descriptive, retrospective and longitudinal study approved by the Ethics Committee was carried out. The study population was constituted by the total of patients with the diagnosis, according to the Acute Kidney Injury Network (AKIN). Characteristics and variables like: reason for the invasive mechanical ventilation, its duration, hemodialysis, and status of the patient at time of discharge were taken into account, along with the characteristics of the kidney injury (stages and etiology). Results: 47.5 % of the patients treated with life support showed acute kidney injury, especially the ones with more than a week of mechanical ventilation (68.4 %). The risk of death was higher in the patients with mechanical ventilation and hemodialysis. In the patients with stage 2 and 3 of the scale used for kidney injury presented 3 times more risk compared to those who did not require these treatments. Sepsis was the main cause of acute kidney injury (69.4 %). Conclusions: the use of invasive mechanical ventilation and acute kidney injury are deeply related to each other, both of them constitute main issues in the variables of mortality.


Subject(s)
Humans , Respiration, Artificial/methods , Respiration, Artificial/mortality , Kidney Diseases/etiology , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies
4.
Int. braz. j. urol ; 46(2): 194-202, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090584

ABSTRACT

ABSTRACT Objective To evaluate usage of renal artery embolization (RAE) for renal injuries and discuss the indications for this treatment. Materials and Methods A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. Results There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. LGRT was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with HGRT. No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate and multivariate analyses, the AAST renal grade both were significantly associated with undergoing RAE. Conclusions LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Renal Artery/injuries , Embolization, Therapeutic/methods , Kidney/blood supply , Kidney Diseases/therapy , Trauma Severity Indices , Retrospective Studies , Treatment Outcome , Kidney Diseases/etiology , Kidney Diseases/diagnostic imaging , Middle Aged
5.
Rev. chil. pediatr ; 91(1): 51-57, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092787

ABSTRACT

Resumen: Introducción: La nefropatía falciforme (NF) es una complicación poco estudiada en la edad pediátrica, que se manifiesta en diferentes formas, incluyendo la glomerulopatía y la tubulopatía. Objetivo: Descri bir las complicaciones renales agudas y crónicas de niños con anemia de células falciformes (ACF). Pacientes y Método: Estudio de cohorte restrospectiva. Se incluyeron pacientes pediátricos con diagnóstico confirmado de enfermedad de células falciformes que tuvieran estudio nefro-urológico. Se consignó patrón electroforético de hemoglobina, presencia y tipo de afectación renal, y presencia de compromiso cardiológico. Se realizó análisis bivariado para comparar pacientes con y sin NF. Resultados: Se incluyeron 79 pacientes, 59.5% hombres, siendo el patrón electroforético más fre cuente Hb-SS (60.9%). La NF se presentó en el 70% de ellos, con una edad de 114 meses (RIQ 65-157). Las alteraciones más frecuentemente encontradas fueron hiperfiltración glomerular, mi croalbuminuria, lesión renal aguda, hipertensión arterial e hipostenuria. En el análisis bivariado, un ecocardiograma anormal fue más frecuente en los pacientes con NF (84,8% vs 54,3% p = 0,01), así como tuvieron una tendencia a mayor uso de medicamentos nefrotóxicos (74,5% vs 54,2% p = 0,07). Conclusiones: Nuestros hallazgos sugieren que la nefropatía falciforme puede presentarse a tempra na edad, siendo muy frecuente la hiperfiltración glomerular. Las complicaciones cardiopulmonares en ACF se podrían asociar con la presencia NF.


Abstract: Introduction: Sickle cell nephropathy (SCN) is a poorly studied complication of pediatric patients. It appears in different forms, including glomerulopathy, and tubulopathies. Objective: To describe acute and chronic renal complications in patients with sickle cell anemia (SCA). Patients and Method: Re trospective study. Pediatric patients with confirmed diagnosis of sickle cell disease were included who had a nephro-urology study. Hemoglobin electrophoresis pattern, presence and type of renal involvement, and presence of cardiac involvement were recorded. Bivariate analysis was perfor med to compare patients with and without SCN. Results: 79 patients were included, 59.5% of them were men, and the most frequent electrophoresis pattern was Hb-SS (60.9%). The SCN oc curred in 70% of patients with an average age of 114 months (RIQ 65-157). The most frequently observed alterations were glomerular hyperfiltration, microalbuminuria, acute kidney injury, ar terial hypertension, and hyposthenuria. In the bivariate analysis, an abnormal echocardiogram result was presented more frequently in patients with SCN (84.8% vs. 54.3% p = 0.01), as well as more frequent use of nephrotoxic drugs (74.5% vs. 54.2% p = 0.07). Conclusions: Our findings suggest that sickle cell nephropathy may occur at an early age, where glomerular hyperfiltration is very common. Cardiopulmonary complications in patients with SCA may be related to the presence of SCN.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Anemia, Sickle Cell/complications , Kidney Diseases/diagnosis , Kidney Diseases/etiology , Acute Disease , Chronic Disease , Prevalence , Retrospective Studies , Risk Factors , Glomerular Filtration Rate , Kidney Diseases/physiopathology , Kidney Diseases/epidemiology
6.
Braz. j. med. biol. res ; 53(4): e9220, 2020. graf
Article in English | LILACS | ID: biblio-1089355

ABSTRACT

Rab7, an important member of the Rab family, is closely related to autophagy, endocytosis, apoptosis, and tumor suppression but few studies have described its association with renal fibrosis. In the early stage, our group studied the effects of Rab7 on production and degradation of extracellular matrix in hypoxic renal tubular epithelial cells. Because cell culture in vitro is different from the environment in vivo, it is urgent to understand the effects in vivo. In our current study, we established a renal fibrosis model in Rab7-knock-in mice (prepared by CRISPR/Cas9 technology) and wild type (WT) C57BL/6 mice using unilateral ureteral obstruction (UUO). Seven and 14 days after UUO, the expression of the Rab7 protein in WT mice, as well as the autophagic activity, renal function, and the degree of renal fibrosis in WT and Rab7-knock-in mice were examined by blood biochemical assay, hematoxylin-eosin and Masson staining, immunohistochemistry, and western blotting. We found that the Rab7 expression in WT mice increased over time. Furthermore, the autophagic activity constantly increased in both groups, although it was higher in the Rab7-knock-in mice than in the WT mice at the same time point. Seven days after UUO, the degree of renal fibrosis was milder in the Rab7-knock-in mice than in the WT mice, but it became more severe 14 days after surgery. Similar results were found for renal function. Therefore, Rab7 suppressed renal fibrosis in mice initially, but eventually it aggravated fibrosis with the activation of autophagy.


Subject(s)
Animals , Male , Female , Rabbits , Autophagy/physiology , Ureteral Obstruction/complications , rab GTP-Binding Proteins/genetics , Kidney/pathology , Kidney Diseases/etiology , Fibrosis , RNA/isolation & purification , Signal Transduction , Up-Regulation , Mice, Knockout , Reverse Transcriptase Polymerase Chain Reaction , rab GTP-Binding Proteins/metabolism
7.
Rev. Assoc. Med. Bras. (1992) ; 66(supl.1): s17-s24, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057108

ABSTRACT

SUMMARY Type 2 diabetes mellitus is an important public health problem, with a significant impact on cardiovascular morbidity and mortality and an important risk factor for chronic kidney disease. Various hypoglycemic therapies have proved to be beneficial to clinical outcomes, while others have failed to provide an improvement in cardiovascular and renal failure, only reducing blood glucose levels. Recently, sodium-glucose cotransporter-2 (SGLT2) inhibitors, represented by the empagliflozin, dapagliflozin, and canagliflozin, have been showing satisfactory and strong results in several clinical trials, especially regarding the reduction of cardiovascular mortality, reduction of hospitalization due to heart failure, reduction of albuminuria, and long-term maintenance of the glomerular filtration rate. The benefit from SGLT2 inhibitors stems from its main mechanism of action, which occurs in the proximal tubule of the nephron, causing glycosuria, and a consequent increase in natriuresis. This leads to increased sodium intake by the juxtaglomerular apparatus, activating the tubule glomerular-feedback and, finally, reducing intraglomerular hypertension, a frequent physiopathological condition in kidney disease caused by diabetes. In addition, this class of medication presents an appropriate safety profile, and its most frequently reported complication is an increase in the incidence of genital infections. Thus, these hypoglycemic agents gained space in practical recommendations for the management of type 2 diabetes mellitus and should be part of the initial therapeutic approach to provide, in addition to glycemic control, cardiovascular outcomes, and the renoprotection in the long term.


Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Diabetes Mellitus, Type 2/drug therapy , Sodium-Glucose Transporter 2/pharmacology , Sodium-Glucose Transporter 2 Inhibitors/pharmacology , Hypoglycemic Agents/pharmacology , Kidney Diseases/prevention & control , Benzhydryl Compounds/therapeutic use , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/etiology , Diabetic Nephropathies/metabolism , Diabetic Nephropathies/prevention & control , Sodium-Glucose Transporter 2/therapeutic use , Canagliflozin/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Glomerular Filtration Rate , Glucose/metabolism , Glucosides/therapeutic use , Hypoglycemic Agents/therapeutic use , Kidney/drug effects , Kidney/physiopathology , Kidney/metabolism , Kidney Diseases/etiology , Kidney Diseases/metabolism
8.
Rev. medica electron ; 41(4): 850-861, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094093

ABSTRACT

RESUMEN Introducción: la Organización Mundial de la Salud, estima que la enfermedad renal crónica estará incluida dentro de las principales causas de discapacidad para el 2020. La prevalencia en países desarrollados es aproximadamente de 500 a 1400 pacientes por millón de habitantes y la incidencia anual se encuentra alrededor de 350 pacientes por millón de población. Objetivo: determinar la prevalencia de la enfermedad renal oculta e identificar algunos factores de riesgos predisponentes en adultos mayores con diabetes mellitus tipo 2 pertenecientes al Policlínico Universitario "Jimmy Hirzel", Bayamo, Granma, en el período comprendido entre junio 2016 - junio 2017. Materiales y métodos: se realizó estudio observacional descriptivo, de corte transversal en el que se incluyeron 180 gerontes con diabetes mellitus tipo 2. Resultados: se estableció el diagnóstico de enfermedad renal oculta en 167 individuos de 180 sujetos estudiados, el grupo de 70 - 79 años de edad fue el más afectado por la nefropatía crónica, mientras que el sexo femenino y la raza blanca fueron los de mayor prevalencia. Los principales factores de riesgo predisponentes de enfermedad renal oculta fueron: cardiopatía isquémica crónica, dislipemias e hipertensión arterial. Conclusiones: existe una alta morbilidad de enfermedad renal oculta en los senescentes estudiados.


ABSTRACT Introduction: the World Health Organization (WHO) estimates that chronic hidden renal disease (ERC) will be included within the principal causes of disability by 2020. The prevalence in developed countries is around 500 to 1400 patients per million inhabitants, and the yearly incidence is around 350 patients per million people. Objective: to determine the prevalence of the hidden renal disease and to identify some predisposing risk factors in elder people with type II diabetes mellitus belonging to the University Policlinic "Jimmy Hirzel", Bayamo, Gramma, in the period between June 2016 and June 2017. Material and methods: an observational descriptive, cross-sectional study was carried out in 180 elder people with type 2 diabetes mellitus. Results: the chronic hidden renal disease was diagnosed in 167 individuals from the 180 studied subjects; the 70-79 years-old-group was the most affected one by chronic renal disease, while the female sex and white race showed the highest prevalence. The main risk factors predisposing to chronic hidden renal disease were: chronic ischemic heart disease, dyslipidemia and arterial hypertension. Conclusions: there is a high morbidity due to hidden renal disease in the studied senescent people.


Subject(s)
Humans , Female , Aged , Prevalence , Risk Factors , Morbidity , Myocardial Ischemia/etiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/etiology , Diabetes Mellitus, Type 2/epidemiology , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/prevention & control , Renal Insufficiency, Chronic/epidemiology , Dyslipidemias/etiology , Hypertension/etiology , Epidemiology, Descriptive , Cross-Sectional Studies , Diabetic Nephropathies/etiology , Observational Study , Kidney Diseases/etiology
9.
Rev. cuba. endocrinol ; 30(2): e200, mayo.-ago. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1126434

ABSTRACT

RESUMEN Introducción: En las últimas tres décadas la prevalencia de adultos con sobrepeso y obesidad ha aumentado sustancialmente en todo el mundo. La acumulación de grasa abdominal y visceral está altamente correlacionada con efectos adversos renales, a través de la acumulación de tejido adiposo dentro y alrededor de los riñones y la acumulación intrarrenal de matriz extracelular. Esta glomerulopatía relacionada con la obesidad se caracteriza en etapas tempranas por hipertrofia glomerular con o sin glomeruloesclerosis segmentaria focal secundaria. Objetivo: Revisar los mecanismos involucrados en la enfermedad renal relacionada con la obesidad. Métodos: Se realizó una búsqueda bibliográfica en PubMed y Google Académico de 2013 a 2017 sobre este tema. Conclusiones: Los efectos nocivos de la obesidad en la vasculatura renal se deben al aumento de la presión arterial, inflamación, hiperglucemia, lipotoxicidad causada por un exceso de metabolismo no-β-oxidativo de los ácidos grasos, estrés oxidativo y activación de múltiples sistemas neurohumorales. El exceso de grasa visceral es una fuente de citocinas y otros factores que crean un medio de estrés oxidativo e inflamación que contribuyen a la disfunción endotelial, la rigidez vascular y al desarrollo de la aterosclerosis. La hiperfiltración e hipertrofia glomerular causan el daño renal asociado a la obesidad. La hiperfiltración compensatoria, que preserva el filtrado glomerular, se acompaña de expansión del volumen glomerular, incremento en los componentes de la matriz glomerular, células endoteliales y mesangiales. Tras la inflamación ocurre la neovascularización, mecanismo compensatorio para mantener la perfusión de los tejidos lesionados o isquémicos(AU)


ABSTRACT Introduction: The prevalence of overweight and obese adults has increased substantially worldwide, in the last three decades. The accumulation of abdominal and visceral fat is highly correlated with renal adverse effects, through the accumulation of adipose tissue in and around the kidneys and the intrarenal accumulation of extracellular matrix. This obesity-related glomerulopathy is characterized in early stages by glomerular hypertrophy with or without secondary focal segmental glomerulosclerosis. Objective: To review the mechanisms involved in the obesity related renal illness. Methods: A bibliographical search on this topic was carried out in PubMed and Academic Google databases from 2013 to 2017. Conclusions: The harmful effects of obesity on the renal vasculature are due to increased blood pressure, inflammation, hyperglycemia, lipotoxicity caused by an excess of non-β-oxidative metabolism of fatty acids, oxidative stress and activation of multiple neurohumoral systems. Excess visceral fat is a source of cytokines and other factors that create a means of oxidative stress and inflammation contributing to endothelial dysfunction, vascular stiffness and the development of atherosclerosis. Hyperfiltration and glomerular hypertrophy cause kidney damage associated with obesity. Compensatory hyperfiltration, which preserves the glomerular filtration rate, is accompanied by glomerular volume expansion, an increase in the components of the glomerular matrix, endothelial and mesangial cells. Following inflammation, neovascularization occurs, a compensatory mechanism to maintain perfusion of injured or ischemic tissues(AU)


Subject(s)
Humans , Overweight/epidemiology , Kidney Diseases/etiology , Obesity/epidemiology , Review Literature as Topic
10.
Rev. méd. Chile ; 147(7): 891-900, jul. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058619

ABSTRACT

Background: Renal infarction is a rare and usually underdiagnosed entity. Aim: To study the etiology of renal infarction in published series. Material and Methods: A systematic review was carried out selecting 28 series that included 1582 patients. Results: The proposed cause was cardiac or aortic embolism in 718 cases (45%), an arterial injury in 253 (16%), prothrombotic factors in 146 (9%) and other causes in 79 (5%). 291 cases were classified as idiopathic (18.4%). Atrial fibrillation was present in 542 of the 718 patients with cardiac or aortic embolism. Conclusions: The main cause of renal infarction is cardiac or aortic embolism and among this group, most cases are due to atrial fibrillation. One out of five cases is labeled as idiopathic.


Subject(s)
Humans , Infarction/etiology , Kidney/blood supply , Kidney Diseases/etiology , Kidney/pathology
11.
Rev. chil. radiol ; 25(1): 26-34, mar. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1003747

ABSTRACT

Resumen:La granulomatosis con poliangeítis (GPA) es una vasculitis sistémica de pequeño vaso, que afecta más frecuentemente el tracto respiratorio y el riñón. Sus criterios diagnósticos se basan en la clínica, exámenes de laboratorio, imágenes e histología. El 90% son ANCA (anticuerpos anticitoplasma de neutrófilos) positivos. La histología muestra inflamación granulomatosa, necrosis y vasculitis. Los exámenes de imagen son de vital importancia en su estudio inicial y seguimiento, correspondiendo principalmente a técnicas tomográficas. La tomografía Computada (TC) es el método de elección para la evaluación de vía aérea superior y pulmón, con alta sensibilidad en afectación de cavidades nasal/paranasales, árbol bronquial y pulmón. La Resonancia Magnética está indicada en compromiso del sistema nervioso central y corazón. El PET/CT presenta alta sensibilidad en enfermedad tóraco-abdominal, es de utilidad en detectar lesiones no visibles con otras técnicas, y en control de tratamiento. El compromiso renal, de alta ocurrencia en GPA, presenta escasa traducción en las imágenes y es frecuentemente indetectable con imágenes, aunque el PET/CT puede ser positivo en casos de glomerulonefritis acentuada. La radiología simple no debe ser utilizada en el estudio de GPA dado su bajo rendimiento diagnóstico. El tratamiento se basa en terapia corticoidea e inmunosupresora. Las recaídas son frecuentes, por lo que estos pacientes requieren seguimiento a largo plazo.


Abstract:Granulomatosis with polyangiitis (GPA) is a systemic type of vasculitis that affects small vessels, most commonly involving the respiratory tract and kidneys. Diagnosis is based on clinical criteria, laboratory tests, imaging and histology. Ninety percent are ANCA (anti-neutrophilic cytoplasmic antibodies) positive. Histology demonstrates granulomatous inflammation, necrosis and vasculitis. Imaging studies are vital for the initial work-up and follow-up. Computed Tomography (CT) is the method of choice for evaluation of the upper airway and lungs, because of its high sensitivity detecting anomalies of paranasal sinuses, bronchial tree and lungs. Magnetic Resonance is indicated for evaluation of the central nervous system and heart. PET/CT has high sensitivity for thoracic and abdominal disease, is useful at detecting lesions not seen with other imaging techniques, and for follow-up. Renal involvement, very frequent on GPA, is usually undetectable at imaging, but may be seen at PET/CT in cases of marked glomerulonephritis. Plain X-rays should not be used for evaluation of GPA because of their low diagnostic performance. Treatment is based on corticosteroid and immunosuppressive therapy. Relapses are frequent, so these patients require long-term follow-up.


Subject(s)
Humans , Tomography, X-Ray Computed , Granulomatosis with Polyangiitis/diagnostic imaging , Positron-Emission Tomography , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/pathology , Kidney Diseases/etiology , Lung Diseases/etiology
12.
Int. braz. j. urol ; 44(6): 1243-1251, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975668

ABSTRACT

ABSTRACT Introduction: We investigated whether Oltipraz (OPZ) attenuated renal fibrosis in a unilateral ureteral obstruction (UUO) rat model. Materials and Methods: We randomly divided 32 rats into four groups, each consisting of eight animals as follows: Rats in group 1 underwent a sham operation and received no treatment. Rats in group 2 underwent a sham operation and received OPZ. Rats in group 3 underwent unilateral ureteral ligation and received no treatment. Group 4 rats were subjected to unilateral ureteral ligation plus OPZ administration. Transforming growth factor beta-1 (TGF-β1), E-cadherin, nitric oxide (NO) and hydroxyproline levels were measured. Histopathological and immunohistochemical examinations were carried out. Results: TGF-β1, NO and E-cadherin levels in the UUO group were significantly higher than the sham group and these values were significantly different in treated groups compared to the UUO group. In rats treated with UUO + OPZ, despite the presence of mild tubular degeneration and less severe tubular necrosis, glomeruli maintained a better morphology when compared to the UUO group. Expressions of α-SMA in immunohistochemistry showed that the staining positivity decreased in the tubules of the OPZ-treated group. Conclusions: While the precise mechanism of action remains unknown, our results demonstrated that OPZ exerted a protective role in the UUO-mediated renal fibrosis rat model highlighting a promising therapeutic potency of Nrf2-activators for alleviating the detrimental effects of unilateral obstruction in kidneys.


Subject(s)
Animals , Male , Rats , Pyrazines/therapeutic use , Ureteral Obstruction/complications , NF-E2-Related Factor 2/therapeutic use , Kidney Diseases/drug therapy , Thiones , Thiophenes , Ureteral Obstruction/pathology , Ureteral Obstruction/drug therapy , Fibrosis/etiology , Fibrosis/drug therapy , Immunohistochemistry , Cadherins/blood , Rats, Wistar , Disease Models, Animal , Transforming Growth Factor beta1/blood , Hydroxyproline/blood , Kidney Diseases/etiology , Kidney Diseases/pathology , Nitric Oxide/blood
14.
J. bras. nefrol ; 40(1): 10-17, Jan.-Mar. 2018. graf
Article in English | LILACS | ID: biblio-893818

ABSTRACT

ABSTRACT Introduction: Ischemia-reperfusion (IR) injury results from inflammation and oxidative stress, among other factors. Because of its anti-inflammatory and antioxidant properties, the Brazil nut (BN) might attenuate IR renal injury. Objective: The aim of the present study was to investigate whether the intake of BN prevents or reduces IR kidney injury and inflammation, improving renal function and decreasing oxidative stress. Methods: Male Wistar rats were distributed into six groups (N=6/group): SHAM (control), SHAM treated with 75 or 150 mg of BN, IR, and IR treated with 75 or 150 mg of BN. The IR procedure consisted of right nephrectomy and occlusion of the left renal artery with a non-traumatic vascular clamp for 30 min. BN was given daily and individually for 7 days before surgery (SHAM or IR) and maintained until animal sacrifice (48h after surgery). We evaluated the following parameters: plasma creatinine, urea, and phosphorus; proteinuria, urinary output, and creatinine clearance; plasmatic TBARS and TEAC; kidney expression of iNOS and nitrotyrosine, and macrophage influx. Results: Pre-treatment with 75 mg of BN attenuated IR-induced renal changes, with elevation of creatinine clearance and urinary output, reducing proteinuria, urea, and plasmatic phosphorus as well as reducing kidney expression of iNOS, nitrotyrosine, and macrophage influx. Conclusion: Low intake of BN prior to IR-induced kidney injury improves renal function by inhibition of macrophage infiltration and oxidative stress.


RESUMO Introdução: a lesão por isquemia-reperfusão (IR) resulta, entre outros fatores, de inflamação e estresse oxidativo. Devido às suas propriedades anti-inflamatórias e antioxidantes, a castanha-do-brasil (BN) pode atenuar a lesão renal causada por IR. Objetivo: O objetivo foi investigar se a ingestão prévia de BN reduz a lesão e a inflamação renal causadas por IR, melhorando a função renal e o estresse oxidativo. Métodos: Ratos Wistar machos foram distribuídos em seis grupos (N=6/grupo): SHAM (controle), SHAM tratado com 75 ou 150 mg de BN, IR, e IR tratado com 75 ou 150 mg de BN. O procedimento de IR consistiu na nefrectomia à direita e oclusão da artéria renal esquerda por 30 minutos. A castanha foi administrada diariamente e individualmente por sete dias antes da cirurgia (SHAM ou IR), e mantida até o sacrifício (48h pós-cirurgia). Os seguintes parâmetros foram avaliados: creatinina, ureia e fósforo plasmáticos; proteinúria, volume urinário e depuração de creatinina; TBARS e TEAC (capacidade antioxidante) plasmáticos; expressão renal de iNOS e nitrotirosina, e influxo de macrófagos. Resultados: O pré-tratamento com 75 mg de BN atenuou os parâmetros de função renal alterados pela IR, com elevação da depuração de creatinina e o volume urinário, redução da proteinúria, ureia e fósforo plasmáticos, e diminuição da expressão de iNOS, nitrotirosina e da infiltração de macrófagos. Conclusão: A ingestão de baixa quantidade de BN, previamente ao processo de IR, melhora a função renal pela inibição da infiltração de macrófagos e do estresse oxidativo.


Subject(s)
Animals , Male , Reperfusion Injury/prevention & control , Bertholletia , Kidney/blood supply , Kidney Diseases/prevention & control , Phytotherapy , Reperfusion Injury/complications , Random Allocation , Rats, Wistar , Kidney Diseases/etiology
15.
Rev. méd. Chile ; 146(2): 241-248, feb. 2018.
Article in Spanish | LILACS | ID: biblio-961383

ABSTRACT

Renal involvement is a frequent complication in antineutrophil cytoplasmic antibodies (ANCA)associated vasculitides, adding morbidity and mortality, such as chronic kidney disease and the need for renal replacement therapy. With the aim of reaching a consensus on relevant issues regarding the diagnosis, treatment and follow-up of patients with these diseases, the Chilean Societies of Nephrology and Rheumatology formed a working group that, based on a critical review of the available literature and their experience, raised and answered consensually a set of questions relevant to the subject. This document includes aspects related to the clinical diagnosis, the histological characteristics, the therapeutic alternatives to induce and maintain the remission of the disease, relapse surveillance strategies and complementary therapies.


Subject(s)
Humans , Antibodies, Antineutrophil Cytoplasmic/blood , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Kidney Diseases/etiology , Kidney Diseases/therapy , Societies, Medical , Remission Induction , Chile , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/blood , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , Maintenance Chemotherapy
16.
Braz. j. med. biol. res ; 51(3): e7174, 2018. tab, graf
Article in English | LILACS | ID: biblio-889044

ABSTRACT

Excess weight (overweight and obesity) is associated with kidney and cardiovascular disease. The aim of this study was to investigate the association between syndecan-1 and renal function among adolescents with excess weight. A total of 56 students from a public school at Fortaleza, CE, Brazil, were investigated. The adolescents were submitted to anthropometric evaluation, including weight, height, blood pressure and body mass index. Blood and urine samples were collected for the determination of serum lipids (total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides), and the endothelial injury biomarker syndecan-1. Participants' mean age was 16±1 years (range 14-19 years), and 68% were females. Overweight was observed in 4 cases (7.1%) and obesity in 7 (12.5%). Changes in serum lipid levels were more frequent in the overweight group. A positive correlation between syndecan-1 and serum creatinine (r=0.5, P=0.001) and triglycerides (r=0.37, P=0.004), and a negative correlation with glomerular filtration rate (r=-0.33, P=0.02) were found. These findings suggest that adolescents with excess weight present incipient changes at the cellular level that make them more vulnerable to the development of kidney and cardiovascular diseases.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Cardiovascular Diseases/etiology , Endothelium, Vascular/physiopathology , Kidney Diseases/physiopathology , Obesity/physiopathology , Syndecan-1/blood , Biomarkers/blood , Blood Pressure/physiology , Body Mass Index , Brazil/epidemiology , Cross-Sectional Studies , Kidney Diseases/etiology , Kidney Failure, Chronic/physiopathology , Obesity/blood , Obesity/complications , Obesity/epidemiology , Renal Insufficiency, Chronic , Risk Factors , Syndecan-1/urine
17.
Braz. j. med. biol. res ; 51(7): e7315, 2018. tab, graf
Article in English | LILACS | ID: biblio-889116

ABSTRACT

Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically women's kidney health on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state in which acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. Various autoimmune and other conditions are more likely to impact women, with profound consequences for child bearing and the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we know and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.


Subject(s)
Humans , Female , Pregnancy , Kidney Diseases/etiology , Kidney Transplantation , Renal Dialysis , Women's Health , Kidney Diseases/surgery , Kidney Diseases/therapy , Pregnancy Complications/surgery , Pregnancy Complications/therapy , Sex Factors
18.
Int. braz. j. urol ; 43(2): 367-370, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-840820

ABSTRACT

ABSTRACT A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.


Subject(s)
Humans , Female , Adult , Ureteroscopy/adverse effects , Ureteroscopes/adverse effects , Ureterolithiasis/surgery , Parenchymal Tissue/injuries , Hematoma/etiology , Kidney Diseases/etiology , Postoperative Complications/diagnostic imaging , Pressure , Stents/adverse effects , Ureterolithiasis/complications , Parenchymal Tissue/diagnostic imaging , Hematoma/diagnostic imaging , Kidney Diseases/diagnostic imaging
19.
Medisan ; 21(1)ene. 2017. tab
Article in Spanish | LILACS, CUMED | ID: biblio-841642

ABSTRACT

Se realizó un estudio descriptivo y transversal de 53 pacientes hipertensos atendidos en el Policlínico Docente Carlos Juan Finlay de Santiago de Cuba durante 2015, con vistas a determinar, mediante la ecuación de Cockcroft-Gault, el grado de enfermedad renal crónica que presentaban. En la serie predominó el grado 2 de la enfermedad en los mayores de 60 años, en los que tenían un tiempo de diagnóstico entre 11-15 años y en el sexo femenino. Las comorbilidades más encontradas resultaron ser la diabetes mellitus de tipo 2 y las afecciones cardiovasculares; asimismo, como principales factores de riesgo prevalecieron la utilización de fármacos nefrotóxicos (antiinflamatorios no esteroideos), la dislipidemia, la anemia y la obesidad. El empleo de dicha ecuación resulta muy útil en la atención primaria, lo cual permite indicar el tratamiento oportuno y efectuar acciones para prevenir la progresión de esta dolencia


A descriptive and cross-sectional study of 53 hipertensive patients was carried out. They were assisted in Carlos Juan Finlay Teaching Polyclinic in Santiago de Cuba during 2015, aimed at determining, by means of the Cockcroft-Gault equation, the grade of chronic renal disease that they presented. In the series the grade 2 of the disease in those over 60 years, in those that had a diagnosis time among 11-15 years and in emale sex prevailed. The mostly found comorbidities were the type 2 diabetes mellitus and cardiovascular disorders; also, as main risk factors the use of nephrotoxic drugs (anti-inflammatory non steroids), dyslipemia, anemia and obesity prevailed. The use of this equation is very useful in the primary care, which allows to indicate the opportune treatment and actions taking to prevent the progression of this disease


Subject(s)
Humans , Male , Female , Renal Insufficiency, Chronic/etiology , Hypertension/complications , Kidney Diseases/etiology , Epidemiology, Descriptive , Cross-Sectional Studies , Risk Factors
20.
Rev. méd. Chile ; 144(10): 1351-1355, oct. 2016. ilus
Article in Spanish | LILACS | ID: biblio-845451

ABSTRACT

ANCA mediated vasculitis mainly occur between the fourth and fifth decade of life; therefore, it is very uncommon to see pregnant patients with the disease. Vasculitis may affect significantly the course of pregnancy; in turn pregnancy can change the course of vasculitis. We report a 20 years old woman with ANCA-mediated renal vasculitis lasting 10 years who consulted with a pregnancy of 15 weeks. She was in remission and had amenorrhea attributed to ovarian toxicity due to cyclophosphamide. Pregnancy had an uneventful course with spontaneous delivery at the 37th week, giving birth to a healthy newborn. Proteinuria increased during the course of pregnancy with a mild deterioration of kidney function. During the year after delivery, she had nephrotic proteinuria and a worsening of renal function.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pregnancy Complications/pathology , Vasculitis/pathology , Antibodies, Antineutrophil Cytoplasmic , Kidney Diseases/pathology , Pregnancy Complications/etiology , Pregnancy Complications/blood , Proteinuria , Time Factors , Vasculitis/etiology , Vasculitis/blood , Biopsy , Pregnancy Outcome , Gestational Age , Glomerular Filtration Rate , Kidney Diseases/etiology , Kidney Diseases/blood
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