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1.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(supl.2): 373-381, 2021. graf
Article in English | LILACS | ID: biblio-1279614

ABSTRACT

Abstract COVID-19 is a pandemic associated with systemic clinical manifestations. In this study, we aimed to present a narrative review on kidney involvement in COVID-19. Kidney involvement could be derived from direct cytopathic effects, immunological mechanisms, indirect effects on renal tissue through other mediators, and dysfunction or injury of other organs. The evolution of COVID-19 may be complicated with acute kidney injury (AKI) in a significant percentage of patients, and renal dysfunction seems to be associated with worse prognosis. Patients with chronic kidney disease (CKD) seem to be more susceptible to the severe forms of COVID-19. Patients with renal replacement therapy (RRT) are also a vulnerable population as consequence of their advanced age, underlying comorbidities, impaired immune response, and clustering in hemodialysis centers, with requirements for frequent contact with healthcare services. Kidney transplant patients may be at high-risk due to long-term immunosuppression and comorbidities, hence, managing immunosuppression is imperative. Lastly, renal replacement therapy may be required during COVID-19, and different modalities are discussed based on clinical findings and laboratorial aspects. Therefore, COVID-19 seems to affect kidney by different mechanisms, which contributes for AKI development and increases the severity of the disease. Also, patients with CKD and kidney transplant recipients are at higher risk for COVID-19 and mortality.


Resumo COVID-19 é uma pandemia associada a manifestações clínicas sistêmicas. Neste estudo, apresenta-se revisão narrativa acerca do envolvimento renal na COVID-19. Envolvimento renal parece ser relacionado a efeitos citopáticos diretos, mecanismos imunológicos, efeitos indiretos de outros mediadores no tecido renal, além de disfunção e lesão de outros órgãos. A evolução da COVID-19 pode ser complicada por lesão renal aguda (LRA) em percentual significativo dos pacientes, e a disfunção renal parece ser associada a pior prognóstico. Pacientes com doença renal crônica (DRC) parecem ser mais suscetíveis a formas severas da COVID-19. Pacientes em terapia de substituição renal (TSR) contínua também constituem população vulnerável em razão de idade avançada, comorbidades subjacentes, resposta imune disfuncional e aglomeração em unidades de diálise, com necessidade de visitas frequentes aos serviços de saúde. Pacientes transplantados renais podem estar em alto risco dadas imunossupressão a longo prazo e comorbidades; assim, o manejo da imunossupressão é mandatório. Finalmente, TSR pode ser necessária durante a COVID-19, e diferentes modalidades são discutidas conforme manifestações clínicas e aspectos laboratoriais. Assim, COVID-19 parece acometer os rins por diferentes mecanismos, os quais contribuem para o desenvolvimento de LRA e aumento da severidade da doença. Ainda, pacientes com DRC e transplantados renais apresentam elevado risco para desenvolvimento de COVID-19 e de mortalidade.


Subject(s)
Humans , Renal Replacement Therapy , Renal Insufficiency, Chronic , Acute Kidney Injury , SARS-CoV-2/pathogenicity , COVID-19/complications , COVID-19/epidemiology , Risk Groups , Comorbidity , Risk Factors , Kidney Transplantation , Kidney/physiopathology
2.
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1335-1337, Oct. 2020.
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136156

ABSTRACT

SUMMARY The COVID-19 (SARS-CoV-2) infection started in China, Wuhan City, Hubei Province, in December 2019, and it was declared a pandemic in mid-March 2020, caused by a new coronavirus strain called SARS-CoV-2. The pathogenesis of kidney injury attributed to SARS- CoV-2 is not well defined yet. Observations show that the kidney damage caused by the new virus mutation is mainly tubular, with impairment of glomerular filtration and high levels of urea and creatinine. A study with seriously ill patients with COVID-19 showed that acute kidney injury was present in 29%. In the face of this evidence, based on recent studies, we can see the great renal contribution as an impact factor in the evolution of COVID-19, not just as a complicator of severity, but maybe part of the initial cascade of the process, requiring a deeper analysis using conventional biomarkers of kidney injury and more aggressive clinical intervention in patients at risk, in an attempt to reduce mortality.


RESUMO Infecção pelo COVID-19 (SARS-CoV-2) começou na China, cidade de Wuhan, província de Hubei, em dezembro de 2019, e foi declarada pandemia em meados de março de 2020, causada por uma nova cepa de coronavírus chamada SARS-CoV-2. A patogênese da lesão renal atribuída à SARS-CoV-2 ainda não está bem definida. Observações mostram que o dano renal causado pela nova mutação viral é principalmente tubular, com comprometimento da filtração glomerular e apresentação de altos níveis de uréia e creatinina. Estudo com pacientes gravemente enfermos com COVID-19 mostrou que a lesão renal aguda estava presente em 29%. Diante dessas evidências, com base em estudos recentes, podemos ver a grande contribuição renal como um fator de impacto na evolução do COVID-19, não apenas como um complicador da gravidade, mas talvez como parte da cascata inicial do processo, exigindo uma investigação de análise mais profunda usando biomarcadores convencionais de lesão renal e intervenção clínica mais agressiva em pacientes em risco, na tentativa de reduzir a mortalidade.


Subject(s)
Humans , Pneumonia, Viral , Coronavirus Infections/pathology , Acute Kidney Injury/virology , Kidney/virology , Coronavirus Infections , Pandemics , Betacoronavirus , Kidney/physiopathology
3.
Rev. chil. pediatr ; 91(3): 324-329, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126168

ABSTRACT

Resumen: El recién nacido prematuro se enfrenta a las condiciones extrauterinas con sistemas aún inmaduros, tanto anatómica como fisiológicamente. El riñón termina de desarrollarse a finales del tercer trimes tre del embarazo, por lo que está especialmente expuesto a alterar su desarrollo normal en caso de nacer en forma prematura. Esta situación puede condicionar, entre otras consecuencias, una menor masa renal funcional y cambios microvasculares que representan un riesgo elevado de hipertensión arterial y daño renal crónico en el largo plazo. En el presente artículo se analiza la evidencia existente actual sobre estos riesgos en los prematuros y se ofrece un esquema de seguimiento de estos niños desde el punto de vista nefrológico.


Abstract: The premature newborn faces extrauterine conditions with some systems still immature, both ana tomically and physiologically. The kidney finishes developing at the end of the third trimester of pregnancy, so it is especially exposed to alter its normal development if preterm birth occurs. This si tuation may condition, among other consequences, a lower functional renal mass and microvascular changes comprising a high risk of chronic kidney disease in the long term and arterial hypertension. This article analyzes the current evidence on these risks in premature infants and offers a nephrology follow-up scheme of these children.


Subject(s)
Humans , Infant, Newborn , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/etiology , Hypertension/physiopathology , Hypertension/therapy , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Infant, Premature, Diseases/physiopathology , Infant, Premature, Diseases/therapy , Risk , Aftercare/methods , Kidney/growth & development , Kidney/embryology , Kidney/physiopathology , Nephrology/methods
4.
Rev. Assoc. Med. Bras. (1992) ; 66(supl.1): s45-s54, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057110

ABSTRACT

SUMMARY INTRODUCTION: Acute kidney injury (AKI) is highly prevalent today. It has a multifactorial aetiology and affects people of all ages, genders and ethnicities. Its treatment is essentially supportive of renal function substitution, so new treatment alternatives such as mesenchymal stem cell therapy (MSCs) should be investigated. METHODS: This review encompasses our understanding of the main mechanisms of action of MSCs in preclinical models of AKI by renal pedicle clamping ischemia-reperfusion, chemotherapy (cisplatin) and kidney transplantation in small and large animals, as well as outcomes in patients with AKI due to ischemia and kidney transplantation. RESULTS: Cellular therapy with MSCs has benefits in preclinical studies of AKI through various mechanisms, such as anti-inflammatory, antiapoptotic, oxidative anti-stress, antifibrotic, immunomodulatory and proangiogenic. In humans, MSC therapy is safe and effective. However, the challenges of MSC cell therapy include investigating protocols about the optimal dose of these cells, the route and frequency of appropriate administration, and the design of further biodistribution studies over a long follow-up period. In addition, a better understanding of molecular signalling and cellular interactions in the microenvironment of each organ and tissue is needed in order to define the best time to administer MSCs. Another challenge would be to mitigate the heterogeneity of the profile of cultured MSCs through preconditioning approaches. CONCLUSIONS: Cellular therapy with MSCs is very promising and should be part of the treatment of AKI patients in combination with other approaches already available, helping to accelerate recovery and/or slow the progression to chronic kidney disease. Randomized, multicentre controlled studies are needed to develop robust protocols that validate population-based cell therapy with MSCs.


Subject(s)
Humans , Animals , Mesenchymal Stem Cell Transplantation/trends , Acute Kidney Injury/therapy , Mesenchymal Stem Cells , Kidney/physiopathology , Tissue Distribution , Mesenchymal Stem Cell Transplantation/methods
5.
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
6.
Braz. j. med. biol. res ; 53(6): e8625, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1132515

ABSTRACT

Amyloidosis comprises a group of disorders that accumulate modified autologous proteins in organs, mainly the kidneys. Few studies have addressed the amyloid compartmental distribution and associated clinical outcomes. The aim of this study was to present a case series of renal amyloidosis correlating histopathological data with glomerular filtration rate (GFR) during kidney biopsy. We studied 53 cases reviewed by nephropathologists from 2000 to 2018 in a single kidney biopsy center in Brazil. GFR was estimated using the CKD-EPI formula. Cases were divided into Group A ≥60 and Group B <60 mL·min−1·(1.73 m2)−1 using the estimated GFR during kidney biopsy. Semiquantitative histopathological study was performed, including extension and distribution of amyloid deposits by compartments (glomeruli, tubulointerstitial tissue, and vessels). Statistical analyses were made to understand associations with lower GFR. No difference was seen for age, gender, proteinuria, hematuria, subtype of amyloid protein, arteriosclerosis, interstitial fibrosis/infiltrate, or glomerular and interstitial amyloid deposits. After a previous P value <0.1 in the descriptive analysis, the following variables were selected: globally sclerotic glomeruli, high blood pressure, and the extension of vascular amyloid deposition. A binary logistic regression model with GFR as the dependent variable showed history of hypertension and vascular amyloid to be robust and independent predictors of Group B <60 mL·min−1·(1.73 m2)−1. Beyond the histopathologic diagnosis of amyloidosis, a semiquantitative approach on renal biopsy could provide new insights. Vascular amyloid is an independent predictor of renal dysfunction in cases of renal amyloidosis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Glomerular Filtration Rate , Amyloid/physiology , Amyloidosis/pathology , Kidney/pathology , Kidney Diseases/pathology , Biopsy , Retrospective Studies , Amyloidosis/physiopathology , Kidney/physiopathology , Kidney Diseases/physiopathology
7.
J. bras. nefrol ; 41(4): 481-491, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056601

ABSTRACT

Abstract Introduction: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. Objective: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). Methodology: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. Results: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. Conclusion: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.


Resumo Introdução: Não se sabe ao certo se a função renal residual (FRR) de pacientes dialíticos pode atenuar o impacto metabólico do maior intervalo interdialítico (MII) de 68 horas, no qual ocorre acúmulo de volume, ácidos e eletrólitos. Objetivo: Avaliar os níveis séricos de eletrólitos, balanço hídrico e status ácido-básico de pacientes dialíticos com e sem FRR ao longo do MII. Metodologia: Tratou-se de estudo unicêntrico, transversal e analítico, que comparou pacientes com e sem FRR, definida como diurese acima de 200 mL em 24 horas. Para tal, os pacientes foram pesados e submetidos à coleta de amostras séricas para análise bioquímica e gasométrica no início e fim do MII. Resultados: Foram avaliados 27 e 24 pacientes com e sem FRR, respectivamente. Pacientes sem FRR apresentaram maior aumento de potássio sérico durante o MII (2,67 x 1,14 mEq/L, p < 0,001) atingindo valores mais elevados no fim (6,8 x 5,72 mEq/L, p < 0,001); menor valor de pH no início do intervalo (7,40 x 7,43, p = 0,018), maior proporção de pacientes com bicarbonato sérico < 18 mEq/L (50 x 14,8 %, p = 0,007) e distúrbio ácido-básico misto (70,8 x 42,3 %, p = 0,042), além de maior ganho de peso interdialítico (14,67 x 8,87 mL/kg/h, p < 0,001) e menor natremia (137 x 139 mEq/L, p = 0,02) no fim do intervalo. A calcemia e fosfatemia não foram diferentes entre os grupos. Conclusão: Pacientes com FRR apresentaram melhor controle dos níveis séricos de potássio, sódio, status ácido-básico e da volemia ao longo do MII.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Water-Electrolyte Balance/physiology , Renal Dialysis/adverse effects , Renal Insufficiency/blood , Kidney/physiopathology , Phosphates/blood , Potassium/blood , Sodium/blood , Acid-Base Imbalance/physiopathology , Bicarbonates/blood , Weight Gain , Calcium/blood , Cross-Sectional Studies , Disease Progression , Renal Insufficiency/physiopathology , Renal Insufficiency/urine , Renal Insufficiency/therapy , Kidney/metabolism , Kidney/chemistry , Kidney Function Tests/methods
8.
J. bras. nefrol ; 41(4): 534-538, Out.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056606

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rhabdomyolysis/diagnosis , Tissue Donors/statistics & numerical data , Kidney Transplantation/methods , Delayed Graft Function/diagnosis , Acute Kidney Injury/surgery , Research Design , Brazil/epidemiology , Cadaver , Feasibility Studies , Retrospective Studies , Renal Dialysis/statistics & numerical data , Kidney Transplantation/statistics & numerical data , Outcome Assessment, Health Care , Creatinine/blood , Delayed Graft Function/etiology , Acute Kidney Injury/etiology , Glomerular Filtration Rate/physiology , Graft Survival/physiology , Kidney/physiopathology
9.
J. bras. nefrol ; 41(4): 451-461, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056616

ABSTRACT

ABSTRACT Hypertension and Diabetes mellitus are the two main causes of chronic kidney disease that culminate in the final stage of kidney disease. Since these two risk factors are common and can overlap, new approaches to prevent or treat them are needed. Macitentan (MAC) is a new non-selective antagonist of the endothelin-1 (ET-1) receptor. This study aimed to evaluate the effect of chronic blockade of ET-1 receptor with MAC on the alteration of renal function observed in hypertensive and hyperglycemic animals. Genetically hypertensive rats were divided into control hypertensive (HT-CTL) group, hypertensive and hyperglycemic (HT+DIAB) group, and hypertensive and hyperglycemic group that received 25 mg/kg macitentan (HT-DIAB+MAC25) via gavage for 60 days. Kidney function and parameters associated with oxidative and nitrosative stress were evaluated. Immunohistochemistry for neutrophil gelatinase-associated lipocalin (NGAL), ET-1, and catalase in the renal cortex was performed. The HT+DIAB group showed a decrease in kidney function and an increase in NGAL expression in the renal cortex, as well as an increase in oxidative stress. MAC treatment was associated with attenuated ET-1 and NGAL production and increases in antioxidant defense (catalase expression) and nitric oxide production. In addition, MAC prevented an increase in oxidant injury (as measured by urinary hydroperoxide and lipid peroxidation), thus improving renal function. Our results suggest that the antioxidant effect of the ET-1 receptor antagonist MAC is involved in the improvement of kidney function observed in hypertensive and hyperglycemic rats.


RESUMO Hipertensão e Diabetes Mellitus figuram como as duas principais causas de doença renal crônica que culmina em doença renal terminal. Uma vez que os dois fatores de risco são comuns e podem se sobrepor, novas abordagens preventivas e terapêuticas se fazem necessárias. O macitentan (MAC) é um novo antagonista não-seletivo dos receptores da endotelina-1 (ET-1). O presente estudo teve como objetivo avaliar os efeitos do bloqueio crônico dos receptores da ET-1 com MAC sobre a alteração da função renal em animais hipertensos e hiperglicêmicos. Ratos geneticamente hipertensos foram divididos em grupos com animais hipertensos de controle (HT-CTL), hipertensos e hiperglicêmicos (HT+DIAB) e hipertensos e hiperglicêmicos tratados com 25 mg/kg de macitentan (HT-DIAB+MAC25) via gavagem por 60 dias. Foram avaliados função renal e parâmetros associados ao estresse oxidativo e nitrosativo. Exames de imunoistoquímica foram realizados para lipocalina associada à gelatinase neutrofílica (NGAL), ET-1 e catalase no córtex renal. O grupo HT+DIAB exibiu diminuição da função renal e aumento na expressão de NGAL no córtex renal, bem como estresse oxidativo aumentado. O tratamento com MAC foi associado a atenuação da produção de ET-1 e NGAL e maior ativação das defesas antioxidantes (expressão de catalase) e elevação da produção de óxido nítrico. Além disso, o MAC evitou exacerbação da lesão oxidante (medida por hidroperóxidos urinários e peroxidação lipídica), melhorando assim a função renal. Nossos resultados sugerem que o efeito antioxidante do antagonista dos receptores da ET-1 MAC esteja imbricado no aprimoramento da função renal observada em ratos hipertensos e hiperglicêmicos.


Subject(s)
Humans , Animals , Male , Hyperglycemia/complications , Kidney/drug effects , Antioxidants/pharmacology , Rats/genetics , Risk Factors , Endothelin-1/metabolism , Administration, Intravenous , Endothelin Receptor Antagonists/administration & dosage , Endothelin Receptor Antagonists/therapeutic use , Hyperglycemia/chemically induced , Hypertension/complications , Hypertension/physiopathology , Kidney/physiopathology , Kidney/injuries , Antibiotics, Antineoplastic/administration & dosage
10.
Rev. medica electron ; 41(3): 681-697, mayo.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1094076

ABSTRACT

RESUMEN Las glomerulopatías agrupan varias nefropatías con lesiones fundamentalmente del corpúsculo renal y que se expresan principalmente por proteinuria, hematuria, edemas e hipertensión arterial. La presentación clínica varía en dependencia del tipo de enfermedad de que se trate. Constituye la causa más frecuente de enfermedad renal crónica en adultos jóvenes, por lo que su estudio resulta imprescindible sobre todo para el nivel primario de salud. El propósito fue actualizar consideraciones pertinentes sobre la conducta diagnóstica y terapéutica integral ante una glomerulopatía y valorar emisión de recomendaciones al respecto. Se realizó una búsqueda, análisis y síntesis de información a través de Bases de datos ScieLO Cuba, ScieLO regional, Pubmed, Cumed, Clinical Key en el período 2012-2017 con las palabras clave: síndrome nefrótico, glomerulonefritis, diagnóstico, terapéutica, atención integral. El abordaje en las glomerulopatías es integral, multidisciplinario e individualizado. En Cuba constituyen la cuarta causa de enfermedad renal crónica y predomina el síndrome nefrítico agudo postinfeccioso. El método clínico juega en ello un papel trascendental a la hora de reconocer y registrar sus aspectos clínicos, su etiología, su fisiopatología, y los exámenes complementarios que confirman su presencia o sus complicaciones, así como un tratamiento oportuno que garanticen el perfeccionamiento asistencial. El arma más poderosa ante el reto de los trastornos glomerulares es la visión integradora y con enfoque individual y social protagonizado por el médico ante este grupo de nefropatías en adultos.


ABSTRACT Glomerulopathies encompass a group of several renal disorders with lesions, mainly in the renal corpuscle, expressed in proteinuria, hematuria, edemas and arterial hypertension. Their clinical manifestations change in dependence of the kind of disease. They are the most frequent cause of chronic renal disease in young adults; therefore their study is very important above all in the health care primary level. The aim was updating pertinent considerations on the diagnostic behavior and comprehensive therapy in the case of glomerulopathy, and evaluating the emission of recommendations regarding to them. A search, analysis and synthesis of information was carried out in the databases ScieLO Cuba, ScieLO regional, Pubmed, Cumed, and Clinical Key in the period 2012-2017, using the key words nephrotic syndrome, glomerulonephritis, diagnosis, therapeutics, comprehensive care. The approach to glomerulopathies is comprehensive, multidisciplinary and individualized. They are the fourth cause of chronic renal disease; the acute post-infectious nephritic syndrome predominates. The clinical method plays a transcendental role at the moment of recognizing and registering their clinical characteristics, etiology and physiopathology, while complementary tests confirm their presence or complications, and therefore an opportune treatment guarantying the healthcare improvement. The most powerful weapon against the challenge of the glomerular disorders is the integrated vision with an individual and social approach led by the physician in the case of these nephropathies in adults.


Subject(s)
Humans , Young Adult , Urination Disorders , Diabetes Mellitus/etiology , Renal Insufficiency, Chronic/etiology , Glomerulonephritis/complications , Glomerulonephritis/diagnosis , Glomerulonephritis/etiology , Glomerulonephritis/pathology , Glomerulonephritis/blood , Glomerulonephritis/therapy , Glomerulonephritis/epidemiology , Hypertension/etiology , Kidney/physiology , Kidney/physiopathology , Kidney/pathology , Kidney/diagnostic imaging , Kidney Glomerulus/physiopathology , Nephrotic Syndrome/complications , Nephrotic Syndrome/diagnosis , Nephrotic Syndrome/etiology , Nephrotic Syndrome/pathology , Nephrotic Syndrome/blood , Nephrotic Syndrome/therapy , Nephrotic Syndrome/epidemiology , Primary Health Care , Nephrosis, Lipoid
11.
Arch. endocrinol. metab. (Online) ; 63(3): 288-292, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011161

ABSTRACT

ABSTRACT Objective: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The renal resistive index (RRI) is a measure of renal arterial resistance to blood flow. The aim of this study was to investigate the renal resistive index levels of patients with PCOS. Subjects and methods: A total of 216 women were included in this cross-sectional study. The study group consisted of 109 patients with PCOS, and the control group consisted of 107 healthy subjects. The RRI of all subjects was measured using renal Doppler ultrasonography. Results: The patients with PCOS had higher RRI levels in comparison to the healthy subjects (0.64 ± 0.06 vs. 0.57 ± 0.06, p < 0.001). The RRI levels of the patients with PCOS were correlated with systolic blood pressure (p = 0.004, r = 0.268) and with homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.02, r = 0.216). Conclusion: In this study, we observed higher RRI levels in patients with PCOS. High RRI levels may be an indicator of cardiovascular and/or cardiovascular-associated diseases in patients with PCOS.


Subject(s)
Humans , Male , Female , Adult , Polycystic Ovary Syndrome/physiopathology , Kidney/physiopathology , Blood Pressure , Insulin Resistance , Cross-Sectional Studies , Ultrasonography, Doppler, Color , Kidney/diagnostic imaging
12.
Rev. méd. Chile ; 147(5): 628-633, mayo 2019. graf
Article in Spanish | LILACS | ID: biblio-1014271

ABSTRACT

Creatine supplements may transitorily rise serum creatinine levels and mimic a kidney disease. If its use is associated with a high protein diet, the resulting increase in blood urea nitrogen will increase the confusion. Since clinical laboratories usually inform the estimated glomerular filtration rate based on serum creatinine, its elevation may lead to over diagnose a chronic renal failure, with the inherent personal and public health consequences. Creatine supplements are safe and do not cause renal disease. Reports of kidney damage associated with its use are scanty. However, creatine supplements should not be used in people with chronic renal disease or using potentially nephrotoxic medications.


Subject(s)
Humans , Dietary Supplements/adverse effects , Creatine/adverse effects , Kidney/drug effects , Kidney/physiopathology , Kidney Diseases/chemically induced , Risk Factors , Creatinine/blood , Kidney Diseases/physiopathology
13.
Acta cir. bras ; 34(5): e201900503, 2019. tab, graf
Article in English | LILACS | ID: biblio-1010873

ABSTRACT

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


Subject(s)
Animals , Physical Conditioning, Animal/physiology , Muscle, Skeletal/physiopathology , Renal Insufficiency/physiopathology , Reference Values , Swimming/physiology , Body Weight/physiology , Reperfusion Injury/physiopathology , Reproducibility of Results , Rats, Wistar , Muscle Fibers, Skeletal/physiology , Creatinine/blood , Disease Models, Animal , Sedentary Behavior , Kidney/physiopathology , Kidney/blood supply
14.
Rev. Soc. Bras. Med. Trop ; 52: e20180371, 2019. tab, graf
Article in English | LILACS | ID: biblio-990443

ABSTRACT

Abstract INTRODUCTION: The levels of the full-length form of the (pro)renin receptor (PRR), a component of the renin-angiotensin system (RAS), may be reduced in the membranes of kidneys in renal diseases. This study aimed to investigate the RAS components in the kidneys of mice submitted to a combination of a high-fat diet and Schistosoma mansoni infection. METHODS: Female BALB/c mice were maintained on a control or high-fat diet from 3 weeks of age. After 10 weeks on the designated diets, half the mice in each group were infected with S. mansoni cercariae. The blood and kidneys were harvested 8 weeks after infection. RESULTS: The high-fat diet increased the number of eggs in the feces and the number of adult worms in the mesenteric bed. Schistosoma mansoni infection reduced the plasma levels of glucose, triglycerides, and HDL cholesterol in the control and high-fat diet groups. In mice on the control diet, S. mansoni infection resulted in increased expression of IL-6 in the kidneys; however, in mice on the high-fat diet, the levels of IL-6 were reduced and those of superoxide anions were increased. The RAS components evaluated were ACE2, renin, PRR, AT1R, and AT2R, and the levels of PRR were found to be reduced in the kidneys of infected mice on the high-fat diet. CONCLUSIONS: The finding regarding PRR is not yet clear. However, combining a high-fat diet and S. mansoni infection resulted in increased oxidative stress in the kidney that can aggravate hypertension as well as its associated complications.


Subject(s)
Animals , Female , Renin-Angiotensin System/physiology , Schistosomiasis mansoni/complications , Schistosomiasis mansoni/metabolism , Diet, High-Fat/adverse effects , Kidney/metabolism , Obesity/metabolism , Time Factors , Triglycerides/blood , Blood Glucose/analysis , Body Weight/physiology , Schistosomiasis mansoni/physiopathology , Random Allocation , Cholesterol/blood , Actins/analysis , Interleukin-6/analysis , Tumor Necrosis Factor-alpha/analysis , Oxidative Stress/physiology , Kidney/physiopathology , Mice, Inbred BALB C , Obesity/physiopathology
15.
J. bras. nefrol ; 40(4): 339-343, Out.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-984578

ABSTRACT

ABSTRACT Introduction: preeclampsia can be associated with future renal disease. Objectives: To measure changes in renal function overtime in patients with preeclampsia. Methods: urine and serum samples from eleven patients with preeclampsia and eight patients with a normal pregnancy were obtained during pregnancy, postpartum, and 3 years after delivery. Urine podocalyxin, protein, and serum creatinine were measured. Results: after 3 years, there were no significant differences in urinary podocalyxin in patients with or without preeclampsia: 4.34 ng/mg [2.69, 8.99] vs. 7.66 ng/mg [2.35, 13], p = 0.77. The same applied to urinary protein excretion: 81.5 mg/g [60.6, 105.5] vs. 43.2 mg/g [20.9, 139.3] p = 0.23. Serum creatinine was 0.86 mg/dL [0.7, 0.9] vs. 0.8 mg/dL [0.68, 1] p = 0.74 in those with and without preeclampsia. In normal patients, urinary podocalyxin decreased from 54.4 ng/mg [34.2, 76.9] during pregnancy to 7.66 ng/mg [2.35, 13] three years after pregnancy, p = 0.01. Proteinuria decreased from 123.5 mg/g [65.9, 194.8] to 43.2 mg/g [20.9, 139.3], p = 0.12. In preeclampsia patients, urinary podocalyxin decreased from 97.5 ng/mg [64.9, 318.4] during pregnancy to 37.1 ng/mg within one week post-partum [21.3, 100.4] p = 0.05 and 4.34 ng/mg [2.69, 8.99] three years after, p = 0.003. Proteinuria was 757.2 mg/g [268.4, 5031.7] during pregnancy vs. 757.2 mg/g [288.2, 2917] postpartum, p = 0.09 vs. 81.5 mg/g [60.6, 105.5] three years later, p = 0.01. Two patients still had proteinuria after 3 years. Conclusions: in preeclampsia patients, postpartum urinary podocalyxin decreased before proteinuria. After three years, serum creatinine, urinary podocalyxin, and protein tended to normalize, although some patients still had proteinuria.


RESUMO Introdução: a pré-eclâmpsia pode estar associada à doença renal no futuro. Objetivos: medir mudanças na função renal ao longo do tempo em pacientes com pré-eclâmpsia. Métodos: amostras de urina e soro de onze pacientes com pré-eclâmpsia e oito pacientes com gravidez normal foram obtidas durante a gravidez, pós-parto e 3 anos após o parto. Medimos podocalixina na urina, proteína e creatinina sérica. Resultados: após 3 anos, não houve diferenças significativas na podocalixina urinária em pacientes com ou sem pré-eclâmpsia: 4,34 ng/mg [2,69, 8,99] versus 7,66 ng/mg [2,35, 13], p = 0,77. O mesmo se aplicou à excreção urinária de proteínas: 81,5 mg/g [60,6, 105,5] vs. 43,2 mg/g [20,9, 139,3] p = 0,23. A creatinina sérica foi de 0,86 mg/dL [0,7, 0,9] vs. 0,8 mg/dL [0,68, 1] p = 0,74 naqueles com e sem pré-eclâmpsia. Em pacientes normais, a podocalixina urinária diminuiu de 54,4 ng/mg [34,2, 76,9] durante a gestação para 7,66 ng/mg [2,35, 13] três anos após a gravidez, p = 0,01. A proteinúria diminuiu de 123,5 mg/g [65,9, 194,8] para 43,2 mg/g [20,9, 139,3], p = 0,12. Em pacientes com pré-eclâmpsia, a podocalixina urinária diminuiu de 97,5 ng/mg [64,9, 318,4] durante a gravidez para 37,1 ng/mg em uma semana de pós-parto [21,3, 100,4] p = 0,05 e 4,34 ng/mg [2,69, 8,99] três anos depois, p = 0,003. A proteinúria foi de 757,2 mg/g [268.4, 5031.7] durante a gravidez vs. 757,2 mg/g [288.2, 2917] pós-parto, p = 0.09 vs. 81.5 mg/g [60.6, 105.5] três anos depois, p = 0.01. Dois pacientes ainda apresentavam proteinúria após 3 anos. Conclusões: em pacientes com pré-eclâmpsia, a podocalixina urinária pós-parto diminuiu antes da proteinúria. Após três anos, a creatinina sérica, a podocalixina urinária e a proteína tenderam a se normalizar, embora alguns pacientes ainda tivessem proteinúria.


Subject(s)
Humans , Female , Adult , Pre-Eclampsia/physiopathology , Podocytes/pathology , Kidney/physiopathology , Kidney/pathology , Pre-Eclampsia/urine , Pre-Eclampsia/blood , Sialoglycoproteins/urine , Sialoglycoproteins/blood , Time Factors , Pregnancy , Biomarkers/urine , Biomarkers/blood , Prospective Studies , Follow-Up Studies
16.
J. bras. nefrol ; 40(3): 256-260, July-Sept. 2018. tab
Article in English | LILACS | ID: biblio-975904

ABSTRACT

ABSTRACT Introduction: Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates. Methods: Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically. Results: Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA radionuclide imaging. In ten patients (76.9%), open surgical intervention for stones were needed during follow-up. Significant difference was not detected between eGFR before and after surgical intervention (mean 92 versus 106, p = 0.36). Nine of the patients (69.2%) were stone free in the last ultrasonographic examination. Relapses of stone after surgery were seen in 66.6% of patients who underwent surgical intervention. Conclusions: Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.


RESUMO Introdução: A cistinúria é um distúrbio autossômico recessivo causado por defeitos de transporte intestinal e renal da cistina e aminoácidos dibásicos que resultam em urolitíase recorrente e necessidade de intervenção cirúrgica. O presente estudo teve por objetivo avaliar o impacto das intervenções cirúrgicas sobre a função renal por meio da análise da taxa de filtração glomerular estimada. Métodos: Treze pacientes pediátricos com cistinúria acompanhados em uma instituição terciária entre 2004 e 2016 foram incluídos no estudo. Os prontuários médicos foram analisados e utilizados como fonte de dados sobre a apresentação clínica dos pacientes, parâmetros urinários, formação de cálculos, tratamento clínico, intervenção cirúrgica, recidiva de cálculos após procedimento cirúrgico, análise de cálculos, ultrassonografia, resultados de imagens com ácido dimercaptossuccínico marcado com tecnécio metaestável (99mTc-DMSA) e tempo de seguimento. A depuração de creatinina estimada pela fórmula modificada de Schwartz (TFGe) antes e após a cirurgia foi utilizada para avaliar e comparar estatisticamente os níveis de função renal. Resultados: Nove pacientes (69,2%) apresentaram cicatrizes renais detectadas por exame de imagem com 99mTc-DMSA. Dez pacientes (76,9%) necessitaram intervenção cirúrgica aberta por cálculo renal durante o seguimento. Não foram detectadas diferenças significativas entre os valores de TFGe anteriores e posteriores à intervenção cirúrgica (média de 92 vs. 106, p = 0,36). Nove pacientes (69,2%) não apresentaram cálculos no último exame ultrassonográfico. Recidivas de cálculos renais após cirurgia foram observadas em 66,6% dos pacientes submetidos a cirurgia. Conclusões: Intervenções cirúrgicas relativas a cálculos renais são frequentemente necessárias em pacientes com cistinúria. Cicatrizes renais são um achado prevalente em pacientes com cistinúria. De acordo com o presente estudo, cirurgia não afeta negativamente a TFGe de pacientes com cistinúria.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Urinary Calculi/surgery , Cystinuria/physiopathology , Glomerular Filtration Rate , Kidney/physiopathology , Urinary Calculi/complications , Retrospective Studies , Treatment Outcome , Cystinuria/complications , Kidney Function Tests
17.
Int. braz. j. urol ; 44(4): 740-749, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954072

ABSTRACT

ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.


Subject(s)
Humans , Male , Female , Aged , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/physiopathology , Risk Assessment/methods , Kidney/physiopathology , Kidney Neoplasms/surgery , Kidney Neoplasms/physiopathology , Nephrectomy/methods , Postoperative Period , Reference Values , Time Factors , Carcinoma, Renal Cell/pathology , Logistic Models , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Creatinine/blood , Warm Ischemia/methods , Preoperative Period , Glomerular Filtration Rate , Kidney/surgery , Kidney/blood supply , Kidney/pathology , Kidney Neoplasms/pathology , Middle Aged , Nephrectomy/adverse effects
18.
Medisan ; 22(2)feb. 2018. tab
Article in Spanish | LILACS | ID: biblio-894678

ABSTRACT

Se efectuó un estudio descriptivo y transversal de 46 pacientes con más de 18 años de edad, pertenecientes al consultorio 34 del área de salud del municipio de Majagua, provincia Ciego de Ávila, desde septiembre de 2015 hasta febrero de 2016. A todos los integrantes de la serie se les indicaron exámenes complementarios, tales como microalbuminuria, filtrado glomerular, creatinina, conteo de Addis y urea. No se realizaron estudios imagenológicos debido a la lejanía, las dificultades con el transporte y el equipo de ultrasonografía. La alteración de los marcadores renales estuvo presente en la mitad de los afectados con factores de riesgo, lo cual permitió detectar la enfermedad renal crónica de manera precoz en ese grupo poblacional


A descriptive and cross-sectional study of 46 patients older than 18 years, belonging to the doctor's office 34 of the health area in Majagua, Ciego de Ávila, was carried out from September, 2015 to February, 2016. The complementary tests were indicated to all the members of the series, such as microalbuminuria, glomerular filtration rate, creatinine, Addis and urea counts . The imagenologic studies were not carried out due to the long distance, difficulties with the transportation and the ultrasonography equipment. The disorder of renal markers was present in half of those affected patients with risk factors, which allowed to detect earlier the chronic renal disease in that population group


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Biomarkers , Risk Factors , Renal Insufficiency, Chronic/epidemiology , Kidney/physiopathology , Primary Health Care , Epidemiology, Descriptive , Cross-Sectional Studies
19.
Braz. J. Pharm. Sci. (Online) ; 54(1): e17165, 2018. tab, graf, ilus
Article in English | LILACS | ID: biblio-889442

ABSTRACT

ABSTRACT It is widely known that high fat diet (HFD) can contribute to the advent of health problems. Recent studies have indicated that obesity imposes a hemodynamic overload to the kidneys. In order to further investigate such injuries, two groups of six Swiss mice each were fed with a controlled AIN93G diet or a high fat (AIN93G modified) diet for eight weeks. Blood samples were collected to determine the hormonal, lipid profile, glucose, urea, and creatinine levels. Histopathological and immunohistochemical analysis were carried out to analysis the kidney damage. Fractions of renal membranes were prepared to assess the Na,K-ATPase activity, lipid peroxidation, total cholesterol, and phospholipid content. The results indicated that the blood lipid profile, urea and creatinine was not altered by the HFD. On the other hand, it was observed in HFD diet mice elevated glucose blood levels along with an augment on insulin and a decrease on corticosterone release. HFD provoked a reduction in the diameter of the convoluted tubules and cell volume in Bowman's capsule and an increased number of positive cells with Na,K-ATPase, but reduced the Na,K-ATPase activity and the cholesterol content in the kidney cell membrane but favored the lipid peroxidation.


Subject(s)
Animals , Male , Mice , Sodium/analysis , H(+)-K(+)-Exchanging ATPase/analysis , Diet, High-Fat/adverse effects , Immunohistochemistry/methods , Cell Membrane , Statistical Analysis , Renal Insufficiency/physiopathology , Kidney/physiopathology
20.
Yonsei Medical Journal ; : 265-272, 2018.
Article in English | WPRIM | ID: wpr-713094

ABSTRACT

PURPOSE: Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS: A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction < 50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS: In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p < 0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION: There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.


Subject(s)
Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory , Echocardiography , Female , Heart/physiopathology , Humans , Hypertension/diagnostic imaging , Kidney/physiopathology , Kidney Function Tests , Male , Middle Aged , Regression Analysis , Systole/physiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/physiology
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