ABSTRACT
ABSTRACT Purpose This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. Methods Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. Results there is a correlation between the occurrence of renal damage as a function of time (p <0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. Conclusion the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.
Subject(s)
Animals , Female , Renal Artery/pathology , Renal Veins/pathology , Ischemia/pathology , Kidney/blood supply , Kidney/pathology , Nephrectomy/methods , Reference Values , Swine , Time Factors , Biopsy , Reproducibility of Results , ConstrictionABSTRACT
PURPOSE: This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. METHODS: Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. RESULTS: there is a correlation between the occurrence of renal damage as a function of time (p < 0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. CONCLUSION: the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.
Subject(s)
Ischemia/pathology , Kidney/blood supply , Kidney/pathology , Nephrectomy/methods , Renal Artery/pathology , Renal Veins/pathology , Animals , Biopsy , Constriction , Female , Reference Values , Reproducibility of Results , Swine , Time FactorsABSTRACT
Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46-26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.
ABSTRACT
O tratamento MARS (Molecular Adsorbent Recirculating System) permite a remoção de toxinas hepáticas ligadas à albumina. Dentre estas substâncias estão os ácidos biliares, que têm importante papel no prurido nas síndromes colestáticas. Relato do Caso: Descrição da primeira experiência brasileira ambulatorial de diálise MARS em paciente de 39 anos, sexo feminino, com diagnóstico de cirrose biliar primária e prurido recorrente após transplante de fígado e refratário às medidas clínicas, havendo também importante comprometimento na qualidade de vida. Após a realização de 2 sessões consecutivas do tratamento MARS, houve controle do prurido por pelo menos 7 meses. Procedimento bem tolerado e sem intercorrências Conclusão: O tratamento MARS é uma opção para pacientes com prurido intratável secundário a síndromes colestáticas e está associado à reduzida taxa de complicações
Subject(s)
Liver Cirrhosis, Biliary/therapy , Hemodiafiltration , Liver Cirrhosis, Biliary , PruritusABSTRACT
Utilizamos ratos com diabetes insipidus congênito (Brattlelboro), submetidos a reduçäo de 5/6 da massa renal total, a fim de avaliarmos a participaçäo do hormônio antidiurético (HAD) na funçäo renal do rim remanescente. Verificamos que, na ausência do HAD, näo ocorre hiperfiltraçäo adaptativa, ou seja, a filtraçäo glomerular global se manteve reduzida e a filtraçäo glomerular por néfron foi normal. Esses resultados säo bastante distintos do que ocorre com outras raças de ratos, submetidos a similar reduçäo da massa renal. Paralelamente, avaliamos a participaçäo das prostaglandinas (PGs) neste modêlo, através da inibiçäo deste sistema com indometacina. Também verificamos que na ausência do HAD o bloqueio agudo das PGs näo ocasionou alteraçäo na funçäo renal nestes animais. Diferencialmente, em ratos com HAD (Munich-Wistar, a inhibiçäo das PGs na IRC ocasiona diminuiçäo significativa da hiperfiltraçäo glomerular global e por néfron
