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1.
J. bras. nefrol ; 41(3): 393-399, July-Sept. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1040251

ABSTRACT

Abstract Lipoprotein glomerulopathy (LPG) is an uncommon cause of nephrotic syndrome and/or kidney failure. At microscopy, LPG is characterized by the presence of lipoprotein thrombi in dilated glomerular capillaries due to different ApoE mutations. ApoE gene is located on chromosome 19q13.2, and can be identified in almost all serum lipoproteins. ApoE works as a protective factor in atherosclerosis due its interaction with receptor-mediated lipoprotein clearance and cholesterol receptor. Most common polymorphisms include ApoE2/2, ApoE3/2, ApoE3/3, ApoE4/2, ApoE4/3, and ApoE4/4. All age-groups can be affected by LPG, with a discrete male predominance. Compromised patients typically reveal dyslipidemia, type III hyperlipoproteinemia, and proteinuria. LPG treatment includes fenofibrate, antilipidemic drugs, steroids, LDL aphaeresis, plasma exchange, antiplatelet drugs, anticoagulants, urokinase, and renal transplantation. Recurrence in kidney graft suggests a pathogenic component(s) of extraglomerular humoral complex resulting from abnormal lipoprotein metabolism and presumably associated to ApoE.


Resumo A glomerulopatia por lipoproteínas (GLP) é uma patologia rara que causa síndrome nefrótica e/ou insuficiência renal. Na microscopia, a GLP é caracterizada pela presença de trombos de lipoproteínas em capilares glomerulares dilatados devido a diferentes mutações no gene da ApoE. O gene da ApoE está localizado no cromossomo 19q13.2 e pode ser identificado em quase todas as lipoproteínas séricas. A ApoE age como fator de proteção na arterioesclerose por conta de sua interação com a depuração de lipoproteínas mediada por receptores e com o receptor de colesterol. Dentre os polimorfismos mais comuns destacam-se ApoE2/2, ApoE3/2, ApoE3/3, ApoE4/2, ApoE4/3 e ApoE4/4. A GLP pode acometer indivíduos de todas as faixas etárias, com discreta predominância do sexo masculino. Pacientes afetados tipicamente apresentam dislipidemia, hiperlipoproteinemia tipo III e proteinúria. O tratamento da GLP é conduzido com fenofibrato, antilipêmicos, corticosteroides, LDL-aferese, troca de plasma, antiplaquetários, anticoagulantes, uroquinase e transplante renal. Recidiva no enxerto renal indica a existência de componentes patogênicos do complexo humoral extraglomerular resultante de metabolismo lipoproteico anômalo, possivelmente associado a ApoE.


Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Middle Aged , Kidney Diseases/pathology , Kidney Diseases/therapy , Apolipoproteins E/genetics , Sex Factors , Kidney Transplantation , Treatment Outcome , Kidney Diseases/complications , Kidney Diseases/genetics , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/etiology , Mutation , Hypolipidemic Agents/therapeutic use
2.
Saúde Soc ; 28(1): 275-286, jan.-mar. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-991668

ABSTRACT

Resumen Este trabajo se propone identificar los obstáculos que enfrentan individuos jóvenes en tratamiento de diálisis peritoneal, así como examinar las estrategias de afrontamiento que utilizan en la atención renal. Para ello, se llevó a cabo un estudio cualitativo desde una perspectiva crítico-interpretativa. Participaron 12 jóvenes con insuficiencia renal y en tratamiento de diálisis peritoneal, viviendo en Guadalajara, México. Mediante un muestreo por bola de nieve, se seleccionaron siete hombres y cinco mujeres. La información se obtuvo mediante entrevistas narrativas y observación participante, además de conversaciones en WhatsApp y Facebook. Se hizo análisis de contenido. Además del consentimiento informado, se aseguró el anonimato y la confidencialidad de la información. Los resultados desvelan cuatro ejes temáticos que emergen del análisis de la información: Enfrentando dificultades económicas, Viviendo las deficiencias de los servicios de salud, Interferencias en la comunicación con los profesionales sanitarios y En búsqueda permanente de estrategias. Múltiples estrategias se emplean para enfrentar los problemas económicos, la falta de información y el control emocional. Se observó que la falta de recursos económicos es el principal obstáculo que enfrentan los jóvenes en diálisis. Estos jóvenes impulsan estrategias, junto con familiares y sus pares, para afrontar las dificultades.


Abstract This study aims at identifying the obstacles faced by young individuals on peritoneal dialysis treatment, as well as to examine the coping strategies they use in renal care. A qualitative study was carried out from a critical-interpretative approach. Participants were 12 young people with kidney failure, under peritoneal dialysis treatment, who lived in Guadalajara, Mexico. Using a snowball sampling, seven men and five women were selected. The data was obtained through narrative interviews and participant observation, as well as conversations on WhatsApp and Facebook. Content analysis was conducted. In addition to informed consent, anonymity and confidentiality of the information were ensured. Four main themes emerged from data analysis: Facing economic difficulties, Living the health services deficiencies, Interference in communication with health professionals, and The permanent search for strategies. Several strategies are used mainly to solve economic problems, lack of information and emotional control. Lack of economic resources is the main obstacle faced by young people under dialysis treatment. Young people employ strategies together with family members and their peers to face the difficulties encountered.


Subject(s)
Humans , Male , Female , Adaptation, Psychological , Peritoneal Dialysis , Kidney Diseases , Mexico , Qualitative Research , Kidney Diseases/psychology , Kidney Diseases/therapy
3.
Braz. j. med. biol. res ; 51(7): e7315, 2018. tab, graf
Article in English | LILACS (Americas) | 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
4.
J. vasc. bras ; 16(2): f:150-l:161, abr.-jun. 2017. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-859624

ABSTRACT

A doença renovascular aterosclerótica é a principal causa de hipertensão secundária. A história natural da doença demonstra taxas de progressão de 4 a 12% ao ano. Entre os métodos de tratamento existe a angioplastia com stent de artérias renais; porém, poucos estudos clínicos demonstraram seus resultados a longo prazo. Esta revisão sistemática da literatura se propõe a apresentar os resultados a longo prazo (acima de 24 meses) da angioplastia com stent de artérias renais na doença aterosclerótica em relação à função renal e aos níveis pressóricos no controle da hipertensão. Foi realizada uma ampla pesquisa, utilizando os termos apropriados, nas bases de dados LILACS, EMBASE, SCIELO, Cochrane Library e MEDLINE. De um total de 2.170 referências, apenas sete artigos contemplavam todos os critérios de inclusão. Conclui-se que, a longo prazo, há uma estabilização da função renal, redução dos níveis pressóricos e diminuição do número de classes de medicamentos anti-hipertensivos


Atherosclerotic renovascular disease is the most important cause of secondary hypertension. The natural history of the disease reveals progression rates of 4 to 12% per year. Angioplasty with renal artery stenting is one treatment option; but there are few studies that have reported long-term results. The objective of this systematic literature review is to discuss the long-term results (at least 24 months) of angioplasty with stenting of renal arteries for atherosclerotic disease, in terms of renal function and blood pressure levels for control of hypertension. A thorough search was conducted of LILACS, EMBASE, SCIELO, Cochrane Library, and MEDLINE using the appropriate terms. Just seven out of 2170 references identified met all inclusion criteria. It was concluded that over the long term renal function was stabilized, blood pressure levels were reduced, and the number of classes of antihypertensive medication decreased


Subject(s)
Humans , Male , Female , Aged , Angioplasty/methods , Atherosclerosis/diagnosis , Atherosclerosis/therapy , Renal Artery Obstruction/diagnosis , Renal Artery Obstruction/therapy , Stents , Treatment Outcome , Antihypertensive Agents/therapeutic use , Database , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/therapy , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Renal Artery , Sex Factors
5.
Rev. panam. salud pública ; 40(1): 16-22, Aug. 2016. tab, graf
Article in Spanish | LILACS (Americas) | ID: lil-795376

ABSTRACT

RESUMEN Objetivo El objetivo de este estudio fue describir las características demográficas y clínicas de los pacientes con enfermedad renal crónica (ERC), hipertensión arterial o diabetes mellitus y encontrar la asociación entre la presencia de estas patologías y el desarrollo de ERC. Métodos Estudio analítico y de corte transversal. La información procede de la base de datos única de ERC y de pacientes con hipertensión arterial y diabetes, que las entidades obligadas a compensar suministraron a la Cuenta de Alto Costo, reportada con corte al 30 de junio de 2013. Se realizó un análisis descriptivo y se determinó la prevalencia de ERC y enfermedad renal crónica en estadio 5 (ERC5). Se determinó la asociación entre ERC y edad, sexo y la diabetes mediante odds ratio (OR) crudos. Resultados Se analizaron 2 599 419 registros, de los cuales 40% correspondían a personas con ERC. El 74,9% de la población tenía hipertensión y 6,4% tenía diabetes. La prevalencia de ERC fue de 2,81%, y 94,3% de los pacientes se encontraba en estadios 1 a 3. El riesgo de presentar ERC en los pacientes con diabetes es 1,03 (intervalo de confianza de 95% [IC95%] 1,016 – 1,043). En los mayores de 60 años, el riesgo de ERC es 2,15 (IC95% 2,140 – 2,167). Conclusiones El 33,4% de pacientes con hipertensión o diabetes no han sido estudiados para determinar la presencia o ausencia de ERC. Es prioritario aplicar estrategias de prevención secundaria y primaria, para evitar la progresión de ERC y reducir la prevalencia de factores de riesgo como hipertensión y diabetes.


ABSTRACT Objective To describe the demographic and clinical manifestations of patients with chronic kidney disease (CKD), arterial hypertension, and/or diabetes mellitus, and to determine the association between the presence of these pathologies and the development of CKD. Methods Analytic and cross-sectional study. The information, with a cutoff date of 30 June 2013, comes from the integrated database of CKD and patients with hypertension and diabetes, which the Colombian payer entities provided to the national fund for high-cost diseases (Cuenta de Alto Costo). A descriptive analysis was conducted and the prevalence of CKD and stage 5 CKD was determined. Crude odds ratios (OR) were used to determine the association between CKD and age, sex, and diabetes. Results 2,599,419 records were analyzed, of which 40% corresponded to people with CKD. Overall, 74.9% of the population had hypertension and 6.4% had diabetes. The prevalence of CKD was 2.81%, with 94.3% of patients in stages 1 to 3. In patients with diabetes, the risk of presenting CKD is 1.03 (confidence interval of 95% [CI95%] 1.016-1.043). Among persons over 60 years of age, the risk of CKD is 2.15 (CI95% 2.140-2.167). Conclusions 33.4% of patients with hypertension or diabetes have not been studied to determine the presence or absence of CKD. It is a priority to implement strategies for secondary and primary prevention in order to prevent the progression of CKD and reduce the prevalence of risk factors such as hypertension and diabetes.


Subject(s)
Kidney Diseases/prevention & control , Kidney Diseases/therapy , Colombia
7.
rev. cuid. (Bucaramanga. 2010) ; 7(1): 1144-1151, ene.-jun. 2016. tab, ilus
Article in Spanish | LILACS (Americas), BDENF | ID: lil-790021

ABSTRACT

Introducción: La enfermedad renal crónica es resultante de diversas enfermedades crónico degenerativas. El paciente con dicha enfermedad y sometido a hemodiálisis sufre muchos cambios en su estilo de vida. Es por ello que es importante evaluar la prevalencia de los mecanismos de adaptación en el paciente en los aspectos psicológico, afectivo y social. Objetivo: Identificar la prevalencia de los mecanismos adaptativos en el área de lo psicológico, afectivo y social que utiliza el paciente con insuficiencia renal crónica bajo tratamiento de hemodiálisis. Materiales y Métodos: Es un estudio descriptivo de tipo cuantitativo, se utilizó el cuestionario “Mecanismos de adaptación de los pacientes con enfermedad renal crónica en terapia de hemodiálisis”. Se realizó en el año 2010; y presentó un coeficiente del Alfa de Cronbach de 7.0, los datos se analizaron mediante estadística descriptiva. Resultados y Discusión: El estudio arrojó una prevalencia en los mecanismos afectivos, con un 71.4% en la adaptación comprometida; los mecanismos sociales sobresalen con un 61.9% en la adaptación compensatoria; no evidenciando porcentajes favorables en los mecanismos psicológicos. Conclusiones: La mayoría de las personas con enfermedad renal bajo tratamiento de hemodiálisis, utilizan diferentes mecanismos de adaptación a su proceso lo cual depende completamente del ambiente en el que se desarrollan y el acompañamiento familiar que reciben.


Introdução: A doença renal crônica é o resultado de muitas doenças crônicas degenerativas. O paciente com a doença e submetidos a hemodiálise sofre muitas mudanças em seu estilo de vida. É por isso que é importante avaliar a prevalência de mecanismos adaptativos em pacientes nos aspectos psicológicos, emocionais e sociais. Objetivo: Identificar a prevalência de mecanismos adaptativos na área psicológica, emocional e social que utiliza o paciente com insuficiência renal crônica em hemodiálise. Materiais e Métodos: Estudo quantitativo descritivo, o questionário "Mecanismos de adaptação de pacientes com doença renal crônica em hemodiálise" foi usado. A pesquisa foi realizada em 2010; e apresentou coeficiente alfa de Cronbach de 7.0, os dados foram analisados pela estatística descritiva. Resultados e Discussão: O estudo encontrou uma prevalência de mecanismos afetivos de 71,4% empenhados em adaptação; mecanismos sociais de 61,9% na adaptação compensatória; não mostrando percentagens favoráveis nos mecanismos psicológicos. Conclusões: A maioria das pessoas com doença renal em hemodiálise, usam mecanismos diferentes para se adaptar ao processo que depende inteiramente do ambiente em que se desenvolvem eo apoio à família que recebem.


Introduction: Chronic kidney disease is the result of many chronic degenerative diseases. The patient with the disease and undergoing hemodialysis undergoes many changes in your lifestyle. That is why it is important to assess the prevalence of adaptive mechanisms in patients in the psychological, emotional and social aspects. Objective: To identify the prevalence of adaptive mechanisms in the area of the psychological, emotional and social that uses the patient with chronic renal failure on hemodialysis. Materials and Methods: A descriptive quantitative study, the questionnaire "Mechanisms of adaptation of patients with chronic kidney disease on hemodialysis therapy" was used. It was made in 2010; and presented a Cronbach's alpha coefficient of 7.0, the data were analyzed using descriptive statistics. Results and Discussion: The study found a prevalence of affective mechanisms, 71.4% engaged in adaptation; social mechanisms stand with 61.9% in compensatory adaptation; showing no favorable percentages in the psychological mechanisms. Conclusions: Most people with kidney disease on hemodialysis, use different mechanisms to adapt to the process which depends entirely on the environment in which they develop and the family support they receive.


Subject(s)
Humans , Male , Female , Middle Aged , Adaptation, Psychological , Renal Dialysis/instrumentation , Renal Insufficiency, Chronic/epidemiology , Chronic Disease , Kidney Diseases/blood , Kidney Diseases/therapy
9.
Homeopatia Méx ; 85(700): 28-38, ene.-feb.2016.
Article in Spanish | LILACS (Americas) | ID: lil-786721

ABSTRACT

El elemuy, Guatteria gaumeri o Malmea depressa es un árbol que habita en México y Centroamérica, y que debido a las propiedades medicinales de su corteza y su raíz ha sido aprovechado desde la época prehispánica para atender afecciones renales, diabetes mellitus tipo II e hipercolesterolemia, entre otras enfermedades. A principios del siglo XX llamó la atención del médico homeópata mexicano Manuel A. Lizama, quien probó su uso durante una década y registró sus observaciones en el Prontuario de materia médica, publicado en 1913. Desde entonces se han realizado diversas investigaciones dentro y fuera del ámbito homeopático que han confirmado y precisado cuál es la acción medicamentosa de la alfa-asarona y otros componentes del elemuy, pero también han sugerido nuevos atributos que sería conveniente comprobar o descartar a través de estudios científicos. El presente texto hace un recorrido por algunos de los artículos representativos que se han generado sobre la Guatteria gaumeri o Malmea depressa, con la finali ad de que médicos, estudiantes e investigadores actualicen o mejoren sus conocimientos...


The Elemuy, Guatteria gaumeri or Malmea depressa is a tree that grows in Mexico and Central America, and because of the medicinal properties of his bark and roots, it has been used since pre-hispanic times to treat kidney disease, type II diabetes mellitus and hypercholesterolemia, among other diseases. In the early twentieth century it drew the attention of Dr. Manuel A. López a Mexican homeopath, who proved it´s use for a decade and recorded his observations at the Prontuario de Materia Medica, published in 1913. Since then there have been performed several research works into, and out of the homeopathic field that have confirmed and specified the pharmacological action of the alpha-asarone among other components of the Elemuy, but also, new pharmacological properties have been suggested that it would be important to test through scientific works. This text takes us through some representative articles that have been generated on the Guatteria gaumeri or Malmea depressa, in order that doctors, students and researchers update or improve their knowledge about this theme...


Subject(s)
Humans , /therapy , Guatteria gaumeri/pharmacology , Guatteria gaumeri/therapeutic use , Hypercholesterolemia/therapy , Kidney Diseases/therapy , Materia Medica , Pathogenesis, Homeopathic
10.
Brasília; Ministério da Saúde; Versão Preliminar; 2016. 23 p. ilus.
Monography in Portuguese | LILACS (Americas), ColecionaSUS | ID: lil-783971

ABSTRACT

Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.


Subject(s)
Humans , Adult , Primary Health Care/standards , Secondary Care/standards , Urologic Diseases/therapy , Kidney Diseases/therapy , Clinical Protocols/standards , Urology/standards , Urologic Diseases/diagnosis , Pain/physiopathology , Health Care Coordination and Monitoring , Kidney Diseases/diagnosis
11.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.753-770.
Monography in Portuguese | LILACS (Americas) | ID: biblio-971566
12.
Rev. latinoam. enferm. (Online) ; 24: e2794, 2016. tab, graf
Article in English | LILACS (Americas) | ID: biblio-960919

ABSTRACT

Objective: to characterize deaths that occurred, and the association between socio-demographic, clinical, laboratory variables and health-related quality of life and the outcome of death in patients on peritoneal dialysis, over a two year period after an initial assessment. Method: observational, prospective population study with 82 patients on peritoneal dialysis. The instruments used for the first stage of data collection were the mini-mental state examination, a sociodemographic, economic, clinical and laboratory questionnaire and the Kidney Disease and Quality of Life-Short Form. After two years, data for characterization and occurrence of death in the period were collected. The relative risk of death outcome was calculated through statistical analysis; the risk of death was estimated by the survival Kaplan-Meier curve, and determined predictors of death by the Cox Proportional Hazards Model. Results: of the 82 original participants, 23 had as an outcome death within two years. The increased risk for the outcome of death was associated with a lower mean score of health-related quality of life in the physical functioning domain. Conclusion: the worst health-related quality of life in the physical functioning domain, could be considered a predictor of death.


Objetivo: caracterizar os óbitos ocorridos e verificar a associação entre as variáveis sociodemográficas, clínicas, laboratoriais, qualidade de vida relacionada à saúde e o desfecho óbito de pacientes em diálise peritoneal, em um período de dois anos após uma primeira avaliação. Método: pesquisa populacional, observacional e prospectiva com 82 pacientes em diálise peritoneal. Foram utilizados, para a primeira etapa de coleta de dados, os instrumentos: Miniexame do Estado Mental, questionário de caracterização sociodemográfica, econômica, clínica e laboratorial e o Kidney Disease and Quality of Life-Short Form. Dois anos depois foram coletados os dados de caracterização e ocorrência de óbito no período. Na análise estatística, foi calculado o risco relativo do desfecho óbito, estimado o risco de óbito pelas curvas de sobrevida de Kaplan-Meier e determinados os preditores de óbito, utilizando o modelo de riscos proporcionais de Cox. Resultados: dos 82 participantes iniciais, 23 tiveram como desfecho o óbito no período de dois anos. O risco aumentado para o desfecho óbito foi associado com ter menor escore médio de qualidade de vida relacionada à saúde na dimensão funcionamento físico. Conclusão: a pior qualidade de vida relacionada à saúde, na dimensão funcionamento físico, pôde ser considerada preditora de óbito.


Objetivo: caracterizar las muertes ocurridas y verificar la asociación entre las variables sociodemográficas, clínicas, de laboratorio, de calidad de vida relacionada a la salud con el resultado de muerte de pacientes en diálisis peritoneal, en un período de dos años, después de una primera evaluación. Método: investigación poblacional, observacional y prospectiva con 82 pacientes en diálisis peritoneal. Fueron utilizados, para la primera etapa de recolección de datos, los instrumentos: Miniexamen del Estado Mental, cuestionario de caracterización sociodemográfica, económica, clínica y de laboratorio y el Kidney Disease and Quality of Life-Short Form. Dos años después fueron recolectados los datos de caracterización y ocurrencia de los muertes en el período. En el análisis estadístico, fue calculado el riesgo relativo del resultado de muerte, estimado el riesgo de muerte por las curvas de supervivencia de Kaplan-Meier y determinados los predictores de muerte, utilizando el modelo de riesgos proporcionales de Cox. Resultados: de los 82 participantes iniciales, 23 tuvieron como resultado la muerte en el período de dos años. El riesgo aumentado para el resultado de muerte fue asociado con menor puntaje promedio de calidad de vida relacionada a la salud, en la dimensión funcionamiento físico. Conclusión: la peor calidad de vida relacionada a la salud, en la dimensión funcionamiento físico, puede ser considerada predictora de muerte.


Subject(s)
Humans , Quality of Life , Peritoneal Dialysis/mortality , Proportional Hazards Models , Health Status , Prospective Studies , Surveys and Questionnaires , Kaplan-Meier Estimate , Kidney Diseases/mortality , Kidney Diseases/therapy
13.
Rev. bras. cardiol. invasiva ; 23(2): 84-90, abr.-jun. 2015. tab, graf
Article in Portuguese | LILACS (Americas), SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-786988

ABSTRACT

Introdução: Cardiodesfibriladores implantáveis (CDIs) são geralmente indicados para pacientes com arritmias malignas considerados de alto risco. A hiperatividade simpática desempenha um papel crítico no desenvolvimento, na manutenção e no agravamento de arritmias ventriculares. Novas opçõesde tratamento nessa população representam uma necessidade clínica. Nosso objetivo foi relatar osresultados de pacientes com CDIs e tempestade elétrica submetidos à denervação simpática renal paracontrole da arritmia. Métodos: Oito pacientes com CDIs internados por tempestade elétrica refratária ao tratamento médico otimizado foram submetidos à denervação simpática renal. Condições subjacentes foram: doença de Chagas (n = 6), cardiomiopatia dilatada não isquêmica (n = 1) e cardiomiopatia isquêmica (n = 1). As informações sobre o número de taquicardias ventriculares/fibrilações ventriculares e episódios de terapiasantitaquicardia na última semana pré-procedimento e nos 30 dias pós-tratamento foram obtidas por meiode interrogação dos CDIs. Resultados: As medianas dos episódios de taquicardias ventriculares/fibrilações ventriculares, sobreestimulaçãoe choques na semana que antecedeu a denervação simpática renal foram de 29 (9 a 106), 23 (2 a 94) e 7,5 (1 a 88), sendo significativamente reduzidas para 0 (0 a 12), 0 (0 a 30) e 0 (0 a 1), respectivamente, 1 mês após o procedimento (p = 0,002; p = 0,01; p = 0,003). Nenhum paciente morreu durante o acompanhamento. Não ocorreram complicações maiores relacionadas ao procedimento.Conclusões: Em pacientes com CDIs e tempestade elétrica refratária ao tratamento médico otimizado, a denervação simpática renal reduziu significativamente a carga de arritmia e, consequentemente, as sobre-estimulações e os choques. Ensaios clínicos randomizados, no contexto de denervação simpática renal para controle de arritmias cardíacas refratárias, são necessários para trazer maior robustez aos nossos achados.


Background: Implantable cardioverter-defibrillators (ICDs) are usually indicated for patients with malignant arrhythmias considered as high risk. Sympathetic hyperactivity plays a critical role in thedevelopment, maintenance, and worsening of ventricular arrhythmias. New treatment options in thispopulation represent a clinical necessity. This study’s objective was to report the outcomes of patients with ICDs and electrical storm submitted to renal sympathetic denervation for arrhythmia control. Methods: Eight patients with ICDs admitted for electrical storm refractory to optimal medical therapy underwent renal sympathetic denervation. Underlying diseases included Chagas disease (n = 6), non-ischemic dilated cardiomyopathy (n = 1), and ischemic cardiomyopathy (n = 1).Information on the number of episodes of ventricular tachycardia/ventricular fibrillation and antitachycardia therapies in the week before the procedure and 30 days after treatment were obtained through interrogation of the ICDs.Results: The median numbers of episodes of ventricular achycardia/ ventricular fibrillation,antitachycardia pacing, and shocks in the week before renal sympathetic denervation were 29 (9 to 106), 23 (2 to 94), and 7.5 (1 to 88), and significantly reduced to 0 (0 to 12), 0 (0 to 30), and 0 (0 to 1), respectively, 1 month after the procedure (p = 0.002; p = 0.01; p = 0.003, respectively). No patients diedduring follow-up. There were no major complications related to the procedure.Conclusions: In patients with ICDs and electrical storm refractory to optimal medical treatment, renal sympathetic denervation significantly reduced arrhythmia load and, consequently, antitachycardia pacing and shocks. Randomized clinical trials in the context of renal sympathetic denervation tocontrol refractory cardiac arrhythmias are needed to further support these findings.


Subject(s)
Humans , Male , Female , Aged , Catheter Ablation/methods , Heart Diseases/etiology , Defibrillators, Implantable , Sympathectomy/methods , Therapeutics , Anti-Arrhythmia Agents/administration & dosage , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/therapy , Renal Artery/physiopathology , Chronic Disease , Prospective Studies , Heparin/administration & dosage , Kidney Diseases/physiopathology , Kidney Diseases/therapy
14.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 28(2): 71-76, abr.-jun. 2015. tab, ilus
Article in Portuguese | LILACS (Americas) | ID: lil-786297

ABSTRACT

A síndrome do QT longo congênito representa importante distúrbio genético, e está associada asíncope, parada cardíaca e morte súbita. O diagnóstico é baseado principalmente na medida do intervalo QT corrigido associada a critérios clínicos e história familiar. A estratificação de risco auxilia na decisão terapêutica. Relatamos o caso de uma paciente com síndrome do QT longo congênito, portadora de marcapasso definitivo e nefropatia espoliadora de magnésio, que evoluiu com necessidade de upgrade para cardiodesfibrilador implantávelna ocasião da troca do gerador do dispositivo.


The congenital long QT syndrome represents an important genetic disorder related to syncope, cardiac arrest and sudden death. The diagnosis is mainly based on corrected QT interval measurement associated with clinical criteria and family history. The risk stratification of patients with long QT syndrome has implications in the prognosis and treatment. We report a case of a patient with congenital long QT syndrome, with cardiac pacemaker who required an upgrade to implantable cardioverter defibrillator at the time of the generator replacement.


Subject(s)
Humans , Female , Aged , Magnesium/adverse effects , Kidney Diseases/therapy , Pacemaker, Artificial , Long QT Syndrome/congenital , Long QT Syndrome/diagnosis , Heart Defects, Congenital/therapy , Defibrillators, Implantable , Drug Therapy/methods
15.
Korean Journal of Urology ; : 412-421, 2015.
Article in English | WPRIM (Western Pacific) | ID: wprim-95913

ABSTRACT

The prevalence of renal disease continues to increase worldwide. When normal kidney is injured, the damaged renal tissue undergoes pathological and physiological events that lead to acute and chronic kidney diseases, which frequently progress to end stage renal failure. Current treatment of these renal pathologies includes dialysis, which is incapable of restoring full renal function. To address this issue, cell-based therapy has become a potential therapeutic option to treat renal pathologies. Recent development in cell therapy has demonstrated promising therapeutic outcomes, in terms of restoration of renal structure and function impaired by renal disease. This review focuses on the cell therapy approaches for the treatment of kidney diseases, including various cell sources used, as well recent advances made in preclinical and clinical studies.


Subject(s)
Cell- and Tissue-Based Therapy/methods , Fetal Stem Cells/transplantation , Humans , Kidney/cytology , Kidney Diseases/therapy , Pluripotent Stem Cells/transplantation , Stem Cell Transplantation/methods
16.
Rev. chil. urol ; 80(1): 26-30, 2015. tab, ilus
Article in Spanish | LILACS (Americas) | ID: lil-786474

ABSTRACT

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...


Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...


Subject(s)
Humans , Adolescent , Female , Abscess/diagnosis , Abscess/therapy , Kidney Diseases/microbiology , Kidney Diseases/therapy , Anti-Bacterial Agents/therapeutic use , Cloxacillin/therapeutic use , Drainage , Furunculosis/complications , Staphylococcal Infections/complications , Radiology, Interventional , Staphylococcus aureus/isolation & purification
17.
Rev. nefrol. diál. traspl ; 34(4): 170-182, dic. 2014. tab, ilus
Article in Spanish | LILACS (Americas) | ID: biblio-908353

ABSTRACT

Introducción: el Registro Latinoamericano de Diálisis y Trasplante Renal (Sociedad Latinoamericana de Nefrología e Hipertensión, SLANH) recoge desde 1991 datos sobre el tratamiento sustitutivo de la función renal (TSFR), cuya prevalencia aumentó de 335 a 576 pmp durante el período 2000-2008. Objetivos: Analizar el crecimiento proporcional de la prevalencia de cada modalidad de tratamiento, Hemodiálisis (HD), Diálisis Peritoneal (DP) y Trasplante Renal Funcionante, y establecer la relación que las modalidades tienen entre sí y con la tasa de nefrólogos pmp. Material y métodos: Se determinaron los porcentajes de crecimiento de las prevalencias por país y por regiones divididas según: a) la SLANH (criterio geográfico); b) el Estudio de Carga Global de Enfermedades de la OMS (GBD-WHO) (criterio epidemiológico). Resultados: El porcentaje de crecimiento de las tasas mostró amplia variabilidad entre las tres modalidades, siendo mayores los de DP. El porcentaje de crecimiento de DP se relacionó en forma inversa con el porcentaje de crecimiento de HD en las regiones 1 (Argentina, Chile, Paraguay y Uruguay) y 4 de SLANH (México, América Central y Caribe) y en todas las regiones de GBD-WHO se relacionó directamente con la prevalencia total del TSFR e inversamente con el porcentaje de crecimiento de HD. La tasa de no se relacionó con el aumento de la prevalencia. Conclusiones: Agrupando los países según criterios epidemiológicos, el crecimiento de DP correlacionó en forma inversa al de HD y directa con la prevalencia total del TSFR. No se observó correlación de esta última con la tasa de nefrólogos por país.


Introduction: the Latin American Dialysis and Renal Transplantation Registry (Latin American Society of Nephrology and Hypertension, SLANH) since 1991, has been collecting data on renal replacement therapy (RRT) whose prevalence increased from 335 to 576 pmp during 2000-2008 period. Objectives: To analyze the proportional increase of each treatment method, Hemodialysis (HD), Peritoneal Dialysis (DP) and Functional Renal Transplantation, and to establish the relationship among them and with the nephrologists rate pmp. Methods: Prevalence increase percentages were determined in each country and regions divided according to: a) the SLANH (geographical criteria); b) Global Burden of Disease study (GBD-WHO) (epidemiological criteria). Results: Percentage growth rate showed wide variability among the three methods, DP being the larger. DP percentage growth was inversely related to HD increase percentage in SLANH regions 1 (Argentina, Chile, Paraguay and Uruguay) and 4 (México, Central America and the Caribbean) and in all GBDWHO regions it was directly related to the total RRT prevalence and inversely to HD percentage growth. Nephrologists rate was not relatedto prevalence increase. Conclusions: Grouping together countries according to epidemiological criteria, DP growth correlated inversely to HD one, and directly to RRT total prevalence. RRT correlation to nephrologists rate by country, was not observed.


Subject(s)
Humans , Kidney Transplantation , Peritoneal Dialysis , Prevalence , Renal Dialysis , Renal Replacement Therapy , Kidney Diseases/therapy , Latin America
18.
Rev. ANACEM (Impresa) ; 8(1): 30-32, jul.2014. ilus
Article in Spanish | LILACS (Americas) | ID: lil-779314

ABSTRACT

El absceso perirrenal es una entidad infrecuente donde la presentación insidiosa y variable favorece el retraso del diagnóstico reportándose una mortalidad de 39-50 por ciento. Nuestro objetivo es presentar y analizar una paciente con absceso perirrenal que recidivó, con énfasis en el tratamiento y diagnóstico. PRESENTACIÓN DEL CASO: Mujer de 56 años consulta en Hospital Regional de Antofagasta por síntomas urinarios de un mes de evolución, reciente aparición de dolor en zona lumbar y fiebre. Se realiza tomografía computarizada: hipodensidad en espacio perirrenal e hiperdensidad en pelvis renal diagnosticándose cálculo coleriforme en pelvis renal y absceso perirrenal. Paciente evoluciona hipotensa: 72/40 mm Hg, posteriormente se realiza lumbotomía exploradora, drenaje e inicio de terapia antibiótica evolucionando favorablemente. Diez días después, vuelve a consultar por sensación febril, eritema y aumento de temperatura local en cicatriz operatoria. Se realiza drenaje percutáneo y tratamiento antibiótico no focalizado debido a urocultivos negativos. Paciente progresa asintomática, con clara reducción deabsceso. La función renal es evaluada con cintigrama informando exclusión funcional renal izquierda, indicándose nefrectomía izquierda. Paciente responde de forma adecuada a antibióticos y procedimientos quirúrgicos dándose de alta. DISCUSIÓN: El absceso perirrenal es una entidad poco sospechada, infrecuente y de difícil manejo donde el diagnóstico precoz adquiere vital importancia. A pesar de lo que recomienda la literatura en casos de abscesos de gran tamaño, el drenaje percutáneo fue efectivo sin recidiva. Como en nuestro caso, la recidiva de esta patología suele ser frecuente por tanto recomendamos evaluar con precisión el tratamiento y el alta del paciente...


The peritoneal abscess is an infrequent entity, the insidious and variant presentation favors delay on the reporting diagnosis with a mortality rate of 39-50 percent. CASE REPORT: A 56 years-old woman with a history of recurrent urinary tract infections asks for help due to urinary-related symptoms, fever and lower back pains. A computed tomography(CT) is performed: hypodensity in the perirenal space and hyperdensity in the renal pelvis. A coral shaped calculus in the renal pelvis along with perirenal abscess is diagnosed. The Patient evolves on a hypotensive way, this is followed the realization of a lumbotomy incision, drainage and antibiotic therapy. Evolving favorably, she is discharged. Ten days later, she consulted again due to a feverish sensation, erythema and increased local temperature on the operation scar. A percutaneous drainage is performed along with the initiation on a non-focal antibiotic treatment due to negative urine culture. The patient progressed asymptomatically with a clear reduction of the abscess. Renal function was evaluated with a reported scintigram process of the left kidney. Left nephrectomy is pointed out. The patient responds appropriately to the antibiotic therapy and surgical procedures. she was discharged being summoned to the urology clinic. DISCUSSION: The perirenal abscess is a rare and unwieldy entity, where an early diagnosis is imperative. Despite what the literature recommends in cases of large abscesses, percutaneous drainage was effective without recurrence. As in our case, the recurrence of this condition is usually prevalent therefore recommend to accurately assess treatment and patient discharge...


Subject(s)
Humans , Female , Middle Aged , Abscess/diagnosis , Abscess/pathology , Abscess/therapy , Kidney Diseases/diagnosis , Kidney Diseases/pathology , Kidney Diseases/therapy , Anti-Bacterial Agents/therapeutic use , Atrophy/etiology , Drainage , Nephrectomy , Recurrence
20.
Rev. chil. pediatr ; 85(1): 31-39, feb. 2014. graf, tab
Article in Spanish | LILACS (Americas) | ID: lil-708812

ABSTRACT

Introduction: Children with chronic kidney disease (CKD) and receiving peritoneal dialysis (PD) have disorders of mineral metabolism that impact their growth, survival and cardiovascular functions. New molecular markers offer a better understanding of the pathophysiology of this disease. Objective: To characterize some components of mineral metabolism, with emphasis on FGF23/Klotho and cardiovascular functions (CV) of these patients. Patients and Method: Prospective observational cohort study. Exclusion criteria: serum 25 (OH) vitamin D < 20 ng/ml, peritonitis within the last two months and active nephrotic syndrome. Calcemia, phosphemia, parathyroid hormone (PTH), 25 (OH) vitD3, 1.25 (OH) vitD3, FGF23 and Klotho in plasma were measured. FGF23 and Klotho were quantified in healthy children as a control group. Echocardiography was performed calculating the left ventricular mass index (LVMI). Descriptive statistics analysis, Pearson correlation coefficient for association among variables and multivariate analysis were conducted. Results: 33 patients, 16 males, aged between 1.2 and 13.4 years were included. Age of onset for PD: 7.3 +/- 5.0 years, time receiving PD: 13.5 +/- 14.5 months. The plasma concentration of 25 (OH) vitD3 was 34.2 +/- 6.3 pg/ml. Calcemia and phosphemia values were 9.8 ± 0.71 and 5.4 +/- 1.0 mg/dl respectively. PTH was 333 +/- 287 pg/ml. FGF23 in plasma was 225.7 +/- 354.3 pg/ml and Klotho 131.6 +/- 72 pg/ml, and in the controls ( n = 16 ), it was 11.9 +/- 7.2 pg/ml and 320 +/- 119 pg/ml, respectively. The residual and total dose of dialysis (KtV) was 1.6 +/- 1.3 and 2.9 +/- 1.6, respectively. FGF23 levels significantly correlated with calcium (p < 0.001, r = 0.85), and inversely with residual KtV, showing no relationship with phosphemia. Klotho level correlated negatively with residual KtV and also, it showed a negative association with chronological age and age at onset of PD. LVMI > 38 g/m² was confirmed in 20/28 patients...


Introducción: Los niños portadores de Enfermedad renal crónica (ERC) en diálisis peritoneal (DP) presentan alteraciones del metabolismo mineral que afectan su crecimiento, estado cardiovascular y sobrevida. Nuevos marcadores moleculares representan una mejor comprensión de la fisiopatología de esta enfermedad. Objetivo: Caracterizar componentes del metabolismo mineral, con énfasis en FGF23/Klotho, y estado cardiovascular (CV) en este grupo de pacientes. Pacientes y Método: Estudio prospectivo observacional. Criterios de exclusión: niveles de 25 (OH) vitamina D < 20 ng/ml, peritonitis hasta 2 meses previos y síndrome nefrótico activo. Se midió calcemia, fosfemia, paratohormona (PTH), 25 (OH) vitD3, 1,25 (OH) vitD3, FGF23 y Klotho en plasma. Se cuantificó FGF23 y Klotho en niños sanos como grupo control. Se efectuó ecocardiografía, calculándose el índice de masa ventricular izquierda (IMVI). Se realizó análisis estadístico descriptivo, coeficiente de correlación de Pearson para asociación entre variables y análisis multivariado. Resultados: Se incluyeron 33 pacientes, 16 varones, edad 1,2 a 13,4 años. Edad de inicio de DP: 7,3 +/- 5,0 años, tiempo en DP: 13,5 +/- 14,5 meses. El nivel plasmático de 25 (OH) vitD3 fue 34,2 +/- 6,3 pg/ml. Los valores de calcemia y fosfemia fueron 9,8 +/- 0,71 y 5,4 +/- 1,0 mg/dl respectivamente. La PTH fue de 333 +/- 287 pg/ml. El FGF23 en plasma fue de 225,7 +/- 354,3 pg/ml y Klotho 131,6 +/- 72 pg/ml, y en los controles (n = 16) fue de 11,9 +/- 7,2 pg/ ml y 320 +/- 119 pg/ml, respectivamente. La dosis de diálisis (KtV) residual y total fue de 1,6 +/- 1,3 y 2,9 +/- 1.6, respectivamente. El nivel de FGF23 se correlacionó significativamente con la calcemia (p < 0,001, r = 0,85), e inversamente con el KtV residual, sin mostrar relación con la fosfemia. El nivel de Klotho...


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Kidney Diseases/metabolism , Kidney Diseases/therapy , Renal Dialysis , Chronic Disease , Calcium/blood , Kidney Diseases/blood , Fibroblast Growth Factors/metabolism , Phosphorus/blood , Glucuronidase/metabolism , Biomarkers , Minerals/metabolism , Parathyroid Hormone , Prospective Studies
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