RESUMO
Abstract Objective Kidney shortage for pediatric kidney transplantation (PKT) entails the need to use low-weight and age donors, despite the apprehension. The aim of this study was to analyze the pediatric deceased donor kidney transplantations (pDDKT) outcomes in the first year after the procedure, stratified by donor age. Method Retrospective cohort of pDDKTs carried out between January 2013, and January 2018, at a PKT reference hospital in Southern Brazil. Donors were divided into group 1 (≤ 6 years), and group 2 (> 6 years); the analysis of the outcomes was carried out in the same period. Results There were 143 pDDKTs; 51 (35.66%) in group 1; and 92 (64.34%) in group 2. In both groups there were 17 graft losses (11.8%), with vascular thrombosis as the main cause (group 1: 5; group 2: 4). Among the complications, renal artery stenosis (RAS) with indication for angioplasty and stenting was more frequent in group 1 (7.8%; group 2: 2.2%). The 1-year Renal Transplant Recipients' and graft survival did not show significant differences between the groups, (p= = 0.95). However, the Glomerular Filtration Rate analysis was higher in group 2, reaching, in the 12th month, 79.3 mL/min/1,73m2, compared to 69.7 mL/min/1,73m2 in group 1(p= = 0.033). Conclusions Small donors can be considered for pDDKTs, as long as there is an expert team to perform the transplantation.
RESUMO
Lipoprotein glomerulopathy (LPG) is a rare autosomal recessive glomerulopathy associated with the deposition of lipoprotein thrombi in the capillary lumina due to apoE gene mutations. Abnormal plasma lipoprotein profile and marked increase in serum apoliprotein E (apoE) are characteristic clinical data. The compromised patients can present nephrotic syndrome, hematuria, and progressive renal failure. Herein, the authors present the first described case of LPG in a Brazilian male patient, 11 years, who presented with a steroid-resistant nephrotic syndrome. Renal function was normal. Kidney biopsy showed markedly enlarged glomerulus, with dilated capillary loops and weak eosinophilic lipoprotein thrombi in the capillary lumina. Interstitium, tubules, arteries, and veins showed normal histologic aspect. Genotypic study for the apoE gene showed the presence of the alleles E3 and E4. The diagnosis of LPG was then performed. The patient received lipid-lowering treatment. After 2 years of follow-up, renal function is gradually decreasing, with persisting heavy proteinuria, despite a marked decrease in serum cholesterol and triglycerides levels.
A Glomerulopatia por Lipoproteínas (GLP) é uma glomerulopatia autossômica recessiva rara associada à deposição de trombos de lipoproteína nos lúmens capilares devido a mutações do gene de ApoE. Perfil anormal das lipoproteínas do plasma e aumento acentuado no soro de apolipoproteína E (apoE) são dados clínicos característicos. Os pacientes acometidos podem apresentar síndrome nefrótica, hematúria e insuficiência renal progressiva. Aqui, os autores apresentam o primeiro caso descrito de GLP em um paciente brasileiro do sexo masculino, 11 anos, que se apresentou com uma síndrome nefrótica corticoide resistente. A função renal era normal. A biópsia renal mostrou glomérulos marcadamente aumentados, com capilares dilatados e lúmens ocupados por trombos de lipoproteínas fracamente eosinofílicos. Interstício, túbulos, artérias e veias mostraram aspecto histológico normal. O estudo genotípico para o gene apoE mostrou a presença dos alelos E3 e E4. O diagnóstico de GLP foi então realizado. A paciente recebeu tratamento hipolipemiante. Depois de 2 anos de seguimento, a função renal está diminuindo gradualmente, com a persistência de marcada proteinúria, apesar de uma diminuição acentuada dos níveis séricos de colesterol e triglicerídios.