Chikungunya on Kidney Transplant Recipients: Is It the Same?

BACKGROUND: Chikungunya virus (CHIKV) infection is an acute febrile illness with polyarthralgia and arthritis. There are few data about CHIKV infection in kidney transplant recipients (KTR). We report the largest case series of CHIKV infection in this population. METHODS: We retrospectively analyzed 32 cases of CHIKV infection in KTR between January 2016 and December 2017 at Hospital Universitário Walter Cantídio of Federal University of Ceará. RESULTS: All patients had been in endemic areas before the beginning of the symptoms. All presented arthralgia, 15 (46.9%) with joint inflammatory symptoms and 14 (43.8%) evolved to chronic arthralgia. Seven (21.9%) showed acute kidney injury (AKI) by Kidney Disease: Improving Global Outcomes criteria during the acute phase. Acute kidney injury was not related to prednisone use (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.04-2.61, P = 0.3) nor chronic arthralgia (OR, 1.2; 95% CI, 0.2-8.4, P = 0.8) as well as male sex, chronic kidney disease and older than 60 years (OR, 1.7; 95% CI, 0.3-10.3, P = 0.58; OR, 0.4; 95% CI, 0.1-2.7, P = 0.4; and OR, 2.1; 95% CI, 0.3-14.9, P = 0.45, respectively). Hospitalization was associated to AKI (OR, 44.0; 95% CI, 3.8-503.1; P = 0.002), probably due to diarrhea or dehydration. One patient died throughout the study, possibly unassociated with CHIKV infection. CONCLUSIONS: KTR with CHIKV infection have a clinical presentation and evolution similar to those seen in the general population. Kidney function is generally well preserved, with transitory graft dysfunction without negative impact after 3 months from the beginning of the symptoms. Previous costicosteroids use did not relate with AKI or chronic arthralgia.

Resolution of hypercalcemia and acute kidney injury after treatment for pulmonary tuberculosis without the use of corticosteroids.

Abstract. Hypercalcemia caused by tuberculosis is rare and it is usually asymptomatic. Tuberculosis (TB) -related hypercalcemia associated with acute kidney injury (AKI) is rarely reported. We report a case of a 22-year-old immunocompetent man with 1-month history of daily fever, asthenia and weight loss. Laboratory findings on admission included serum calcium 14.9 mg/dL, urinary Ca(2+) 569.6 mg/24 hours, low level of parathyroid hormone, serum creatinine = 2.2 mg/dL and sodium fractional excretion (FeNa) 2.73%. The result of the tuberculin skin test was 17 mm. A chest X-ray revealed micronodular pulmonary infiltrate in the apex of the right lung, which was confirmed by computed tomography scan. The patient was diagnosed with hypercalcemia associated with pulmonary TB and AKI. A general improvement of the hypercalcemia and renal function was observed in the first 2 weeks after effective hydration and treatment of TB without corticosteroids. The patient was discharged with normal calcium levels and renal function.

O oleo essencial de Lippia gracilis Schauer, Verbenaceae, em ratos diabeticos / The essential oil from Lippia gracilis Schauer, Verbenaceae, in diabetic rats

O óleo essencial das folhas de Lippia gracilis Schauer, Verbenaceae, foi examinado por CG e CG-MS. Quinze constituintes foram identificados, onde o carvacrol, p-cimeno e o γ-terpineno foram as substâncias majoritárias. No estudo in vitro, a solução a 5 por cento do óleo de L. gracilis Schauer apresentou atividade antibacteriana para Staphylococcus aureus isolado de úlcera infectada de paciente diabético. O estudo avaliou a atividade antibacteriana da solução a 5 por cento do óleo de L. gracilis Schauer em modelo experimental em diabetes utilizando ratos albinos Wistar machos com membro pélvico infectado com cepa de Staphylococcus aureus. No experimento foram utilizados 28 ratos Wistar distribuídos em quatro grupos (G1-branco, G2-controle negativo, G3-controle positivo, G4-teste) de sete ratos. Quando comparado o grupo G4 com G3, observou-se que a solução a 5 por cento promoveu uma redução nas CFU/mL após 24h da administração do inóculo (S.aureus sem L. gracilis Schauer 10(8) ± 313 versus S.aureus com L. gracilis Schauer 13,28 ± 4,03). Os resultados foram expressos através do cálculo da média±EPM) e análise de variança (ANOVA). A diferença entre a concentração inibitória mínima no estudo in vitro foi determinada pelo teste Turkey (p<0.05). O teste Newman-Keuls com nível de significância (p<0.05) foi utilizado para o cálculo dos resultados obtidos no experimento in vivo. A solução a 5 por cento do óleo essencial de Lippia gracilis Schauer apresentou boa atividade antibacteriana tanto no estudo in vivo como no in vitro.

The essential oil from Lippia gracilis Schauer (Verbenaceae) leaves was examined by GC and GC-MS. Fifteen constituents were identified. Carvacrol, p-cymene and γ-terpinene were found to be the major components. In the in vitro study, 5 percent solution of the Lippia gracilis Schauer oil presented antibacterial activity against Staphylococcus aureus isolated from diabetic patients with infected ulcers. The study evaluated the antibacterial activity of the 5 percent solution of the Lippia gracilis Schauer oil on the experimental model of diabetic adult male albino Wistar rats with leaft pelvic limb infected by Staphylococcus aureus strain. In this experiment, 28 diabetic Wistar rats were used, randomly distributed in four different groups of seven rats, (G1-white; G2-negative control; G3-positive control and G4-test). When comparing group G4 with G3, it was observed that the 5 percent solution presented a reduced CFU/mL level showing the antibacterial effect of the oil 24 hours after the administration of the inoculum (S .aureus without Lippia gracilis Schauer 108 ±313 versus S.aureus with Lippia gracilis Schauer 13.28±4.03). The results were expressed as mean±S.E.M. One-way analysis of the variance (ANOVA) was used. The differences between the minimum inhibitory concentration in vitro test were determined by the Tukey test (p<0.05). The Newman-Keuls test with level of significance (p<0.05) was used to measure the results in vivo. The findings have shown that 5 percent solution of the Lippia gracilis Schauer oil presented antibacterial activity in vitro and in vivo.

Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification.

BACKGROUND: Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the prevalence, clinical characteristics and outcome of AKI after trauma. PATIENTS AND METHODS: This was a retrospective study performed from January 2006 to January 2008 in an emergency specialized hospital in Fortaleza city, northeast of Brazil. All patients with AKI admitted in the study period were included. Prevalence of AKI, clinical characteristics and outcome were investigated. RESULTS: Of the 129 patients admitted to the intensive care unit (ICU), 52 had AKI. The mean age was 30.1 ± 19.2 years, and 79.8% were males. The main causes of AKI were sepsis in 27 cases (52%) and hypotension in 18 (34%). Oliguria was observed in 33 cases (63%). Dialysis was required for 19 patients (36.5%). Independent risk factors associated with AKI were abdominal trauma [odds ratio (OR) = 3.66, P = 0.027] and use of furosemide (OR = 4.10, P = 0.026). Patients were classified according to RIFLE criteria as Risk in 12 cases (23%), Injury in 13 (25%), Failure in 24 (46%), Loss in 1 (2%) and End-stage in 2 (4%). Overall in-hospital mortality was 95.3%. The main cause of death was sepsis (24%). Mortality was 100% among patients with AKI. CONCLUSIONS: AKI is a fatal complication after trauma, which presented with a high mortality in the studied population. A better comprehension of factors associated with death in trauma-associated AKI is important, and more effective measures of prevention and treatment of AKI in this population are urgently needed.

Determination of urinary stone composition based on stone morphology: a prospective study of 325 consecutive patients in an emerging country.

BACKGROUND: Urolithiasis is a common disease that is increasing throughout the world. This study aimed at determining the composition of urinary stones in patients with renal lithiasis in an emerging country. METHODS: A morphological analysis was performed on 340 urinary stones from 325 consecutive patients from Brazil with lithiasis. RESULTS AND CONCLUSIONS: Among the 340 stones analyzed, 34.7% were pure. The most frequent stone was calcium oxalate (CaOx) (59.3%), followed by uric acid (23.7%). CaOx was more frequently seen in women (p=0.024), while uric acid was more common in men (p<0.001). Among the mixed stones, CaOx (67.1%) was the most frequent major component, followed by carbapatite (11.2%) and struvite (7.9%). CaOx (p<0.001) and uric acid (p=0.014) were more frequently the major components in men, while carbapatite (p<0.001) and struvite (p=0.011) were more frequent in women. The major component of both pure and mixed stones was CaOx (65.1%), followed by uric acid (10.9%), carbapatite (10%), struvite (6.7%), ammonium urate (5.1%), cystine (1.8%) and protein (0.4%). These findings may be related to regional factors, such as weather and nutritional habits.

Clinical presentation and renal evaluation of human visceral leishmaniasis (kala-azar): a retrospective study of 57 patients in Brazil.

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr > or = 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 +/- 18 years old; 74% were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%). Acute renal failure was found in 15 patients (26.3%) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr > or =1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr > or =1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr > or =1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

Clinical presentation and renal evaluation of human visceral leishmaniasis (kala-azar): a retrospective study of 57 patients in Brazil

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr > 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 ± 18 years old; 74 percent were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97 percent), splenomegaly (96.4 percent), weight loss (95.5 percent), pallor (93.6 percent), cough (89.7 percent), hepatomegaly (87.2 percent), asthenia (83.3 percent), anorexia (82.9 percent) and vomiting (73.9 percent). Acute renal failure was found in 15 patients (26.3 percent) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr > 1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr > 1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr > 1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

Aloimunidade contra antígenos HLA de classe I em pacientes com síndromes mielodisplásicas e anemia aplástica / Aloimmunity against HLA class I antigens in patients with myelodisplastic syndrome and aplastic anemia

As síndromes mielodisplásicas (SMD) e a anemia aplástica (AA) apresentam citopenias periféricas necessitando, com freqüência, de reposições transfusionais contínuas de concentrados de hemácias e/ou de concentrados de plaquetas. O objetivo do presente estudo foi verificar a ocorrência de anticorpos anti-HLA de classe I em pacientes portadores das SMD e AA atendidos no ambulatório de Hematologia do Hemoce/UFC. Foram analisados 110 pacientes, sendo 70 com SMD e 40 com AA. A pesquisa de anticorpos anti-HLA de classe I foi realizada frente a um painel (PRA), utilizando-se a técnica de microlinfocitotoxicidade dependente do complemento. Vinte (28,6 por cento) dos 70 pacientes com as SMD e 18 (45 por cento) dos 40 pacientes com AA desenvolveram anticorpos anti-HLA contra o PRA. Esses pacientes que receberam uma carga de antígenos estranhos advindos de múltiplas transfusões de vários doadores de CH e/ou CP, geralmente desenvolvem aloanticorpos contra os antígenos HLA presentes na superfície das plaquetas e dos leucócitos que contaminam esses concentrados. A produção desses anticorpos pode trazer sérias complicações para o tratamento dos pacientes com SMD e AA. As avaliações sistemáticas para detecção de anticorpos anti-HLA após a reposição transfusional podem ser valiosas para adoção de estratégias transfusionais mais adequadas para esta população de pacientes.

Patients with myelodysplastic syndromes (MDS) or aplastic anemia (AA) present peripheral cytopenias and require continuous transfusions of red cell and/or platelet concentrates. The objective of this study is to verify the existence of anti-HLA class 1 antibodies in patients with MDS and AA treated at the hematology Out patient Clinic of Hemoce/UFC. A total of 110 patients were analyzed, 70 with MDS and 40 with AA. Anti-HLA class 1 antibody detection was achieved with an antibody reactivity panel using the complement-dependent microlymphocytotoxicity technique. A total of 20 (28.6 percent) of the 70 patients with MDS and 18 (45 percent) of the 40 patients with AA developed anti-HLA antibodies against the antibody panel. In general, patients who received a load of foreign antigens originating from multi-donor red cell and platelet concentrate transfusions, developed alloantibodies against the HLA antigens that exist on the surface of platelets and on white blood cells that contaminate these concentrates. The production of these antibodies may cause serious complications in the treatment of MDS and AA patientss.

Pionefrose em paciente comcálculo ureteral infectado sem comprometimento do estado geral / Pyonephrosis in a patient with infected ureteral calculus without general state deterioration

Relatamos o caso de uma paciente de 34 anos que apresentou há 2 anos episódios de cólica renal, sendo diagnosticada litíase renal. Há 1 mês houveintensificação dos episódios de dor lombar à esquerda com irradiação para genitália, disúria, polaciúria, urgência urinária, febre alta e calafrios. IniciouCiprofloxacina sem melhora significativa dos sintomas, tendo sido internada para investigação diagnóstica e tratamento. Ao exame físico encontrava-sehipocorada, taquicárdica e febril. Abdômen doloroso à palpação e presença de massa palpável em hipocôndrio esquerdo. Os exames da admissãomostraram Hemoglobina 6,5g/dL, Leucócitos 17.100/mm3, Plaquetas 656.000/mm3, Creatinina 1,0mg/dL. A ultrassonografia abdominal evidenciounefrolitíase e hidronefrose à esquerda. Foi realizada nefrectomia do rim esquerdo. Na cirurgia o rim esquerdo estava aumentado e com consistênciacística, sem áreas de parênquima normal, com ureter dilatado e grande quantidade de secreção purulenta espessa e esverdeada. No examemicroscópico foram vistos glomérulos retraídos, atrofia tubular, intenso infiltrado inflamatório misto no interstício e áreas abscedadas atingindo inclusivea pelve renal. A paciente apresentou evolução favorável, recebendo alta com função renal normal e sem complicações no seguimento.

We report the case of a 34 years-old woman who had episodes of renal colic and a diagnosis of renal calculi. One month before admission she notedexacerbation of left-side lumbar pain, which irradiated to genital region, dysuria, polacyuria, urinary urgency and high degree fever, with chills. Treatmentwas started with Ciprofloxacin, but she had no clinical improvement and was admitted to investigation. At physical examination she was pale, tachycardicand febrile. Her abdomen was tender, with a palpable mass on left hypochondrium. The laboratorial tests showed hemoglobin 6.5g/dL, white blood cells17100/mm3, platelets 656,000/mm3, and creatinine 1.0mg/dL. The abdominal ultrasound showed left-side nephrolitiasis and hydronephrosis. It wasperformed left nephrectomy. The surgical description was: left kidney with increased size, with cystic consistence, without areas of normal parenchyma, withdilated ureter and large amount of thick and greenish secretion. At microscopic examination, protracted glomeruli, tubular atrophy and intense interstitialinflammatory infiltrate were observed, with areas of abscesses reaching renal pelvis. The patient had a favorable course and was dismissed with a normalrenal function. She did not present any complication during the follow-up.

Doença renal terminal associada à obstrução crônica do trato urinário por cálculo vesical gigante / End stage renal disease following long-term urinary tract obstruction dDue to giant bladder stone

Cálculos vesicais compreendem 5 de todos os cálculos do trato urinário e estão freqüentemente associados à presença de corpos estranhos, obstrução e infecção. Relatamos o caso de um paciente do sexo masculino, 23 anos, que deu entrada na Emergência do Hospital Geral de Fortaleza com quadro de disúria, peritonite e sinais de uremia. A radiografia abdominal mostrava uma imagem hiperdensa na topografia vesical. A ultrassonografia abdominal mostrava hidronefrose bilateral. Os exames laboratoriais evidenciaram creatinina sérica 7,6 mg/dL, potássio 7,1 mEq/L, pH 7,29, pCO2 15,7 mmHg e HCO37,5 mEq/L. Hemodiálise diária foi instituída devido à severa uremia. Laparotomia foi realizada, sendo os principais achados cirúrgicos coleção purulenta nacavidade pélvica, perfuração na parede lateral da bexiga e divertículo vesical. Um cálculo vesical gigante, com o maior diâmetro de 7 cm, foi identificado e retirado da bexiga. O paciente evoluiu estável, necessitando de hemodiálise três vezes por semana. Este caso ilustra a ocorrência de uma importante complicação de um cálculo vesical gigante, que causou a obstrução crônica do trato urinário, levando ao desenvolvimento de insuficiência renal crônica. A pronta instituição do tratamento dialítico no primeiro dia de internamento e a cirurgia de urgência foram cruciais para a recuperação do paciente que passou a necessitar de hemodiálise regular.