RESUMEN
The prevalences of chronic infection by hepatitis C virus (HCV) and its genotypes vary among countries and ethnic groups. Among patients with end-stage renal disease (ESRD) and transplant recipients, the evolution of hepatic disease seems atypical and has not been established. In this study we compared the prevalence and HCV genotypic distribution among Brazilian patients with ESRD on dialysis or with transplantations. Moreover, we sought to compare the behavior of biochemical markers of hepatic activity of HCV infection in both groups. We prospectively evaluated 87 ESRD patients on dialysis and 105 transplant patients. Blood samples were obtained to perform qualitative HCV-RNA, genotyping, and, periodically, serum levels of aminotransferases (ALT, AST), gamma-glutamyltransferase (GGT), alpha-fetoprotein (AFT), and albumin. The prevalence of HCV in ESRD patients was similar to recipients (19.5% vs 25.7%; P = NS) and the most frequent genotype was 1a. There was no difference in the mean values of ALT, GGT, AFT, and serum albumin between both groups with HCV infection. The mean values of aminotransferases were slightly elevated and a high frequency of patients evolved with persistently normal parameters. In contrast, the mean values of the GGT were 3 or 4 times above the reference limit and a greater frequency of patients evolved with values persistently elevated in the 2 groups. In conclusion, in the 2 groups the prevalence of HCV infection was elevated; the most frequent genotype was 1a. Among the biochemical parameters, GGT seemed to be useful as an indirect marker of liver disease.
Asunto(s)
Hepatitis C/enzimología , Fallo Renal Crónico/enzimología , Trasplante de Riñón/fisiología , Terapia de Reemplazo Renal/efectos adversos , gamma-Glutamiltransferasa/sangre , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Brasil , Femenino , Hepatitis C/epidemiología , Humanos , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/virología , MasculinoRESUMEN
BACKGROUND AND PURPOSE: Patients undergoing parenteral nutrition and those with portosystemic encephalopathy secondary to chronic liver disease and acquired and congenital portosystemic venous shunts frequently present manganese deposition in the basal ganglia, detected by MR imaging as hyperintense areas on T1-weighted sequences. We also observed similar abnormalities in the basal ganglia of patients with chronic renal failure undergoing maintenance hemodialysis. Our aim was to evaluate the pallidal signal intensity on T1-weighted images in a series of patients undergoing hemodialysis, with further evaluation of serum manganese levels and neurologic correlation, comparing them with patients with chronic renal failure without dialytic treatment. MATERIALS AND METHODS: We performed MR imaging examinations in 9 patients with chronic renal failure, 5 of whom were undergoing hemodialysis. An experienced neuroradiologist scrutinized the presence of symmetric hyperintensities in the basal ganglia on T1-weighted sequences. We also determined the serum manganese levels and performed the neurologic evaluations in all patients. RESULTS: All patients undergoing hemodialysis presented elevated serum manganese levels and symmetric hyperintensities within the globus pallidus. In this group, 4 patients presented with parkinsonian symptoms, myoclonus, and syndromes with vestibular and vestibular-auditory symptoms. The patients without dialytic treatment presented with neither bilaterally increased T1 MR imaging signal intensity within the globus pallidus nor symptoms of manganism. CONCLUSION: Our preliminary results demonstrated the occurrence of bilateral pallidal hyperintensity on T1-weighted images in all patients undergoing hemodialysis associated with high serum manganese levels, revealing a new association.
Asunto(s)
Ganglios Basales/patología , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Intoxicación por Manganeso/etiología , Diálisis Renal/efectos adversos , Adulto , Anciano , Femenino , Globo Pálido/patología , Trastornos de la Audición/etiología , Humanos , Masculino , Intoxicación por Manganeso/complicaciones , Persona de Mediana Edad , Mioclonía/etiología , Trastornos Parkinsonianos/etiología , Síndrome , Enfermedades Vestibulares/etiologíaRESUMEN
The aim of this study was to assess the presence of cryoglobulins, the constitution of the cryoprecipitate, as well as the possible etiology and clinical features in kidney transplant recipients. We excluded patients with clinical or laboratory evidence of autoimmune, liver or neoplasm disease, infections, blood transfusions or immunizations in the previous 3 months. Detection of cryoglobulins was obtained from the peripheral venous blood. In cases of cryoprecipitate formation it was analyzed using anti-IgG, anti-IgM, anti-IgA, anti-C3, and anti-C4 antibodies. The hepatitis C virus (HCV) was detected by the polymerase chain reaction. Thirty-nine patients were selected, of whom 23 were men and the overall mean age was 40.6 +/- 12.7 years. Cryoprecipitate was detected in 74.4% (29/39) patients. Among patients with or without cryoprecipitate formation, the serum creatinine values, the percentage of patients with proteinuria, and the posttransplantation times were similar. In patients with cryoglobulins, 37.9% (11/29) were HCV positive. The etiology was not determined for the other patients. The IgG, IgM, and IgA immunoglobulins and the complement fractions C3 and C4 were found in the cryoprecipitate. Their compositions were similar among patients with or without HCV. Few clinical features were associated with the presence of cryoglobulins, including deep venous thrombosis, cutaneous purpura and peripheral neuropathy. In conclusion, cryoglobulinemia was prevalent in kidney transplant recipients, but appeared to not affect graft function. HCV infection was the most frequently associated etiology and clinical features were infrequent.
Asunto(s)
Crioglobulinemia/sangre , Crioglobulinas/análisis , Trasplante de Riñón/efectos adversos , Adulto , Proteínas del Sistema Complemento/inmunología , Femenino , Estudios de Seguimiento , Hepatitis B/sangre , Hepatitis B/complicaciones , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina A/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Factores de TiempoRESUMEN
The aim of this study was to assess the possible association between posttransplant diabetes mellitus (DM) and hepatitis C virus (HCV) infection in renal transplant recipients. This study included 124 patients who underwent renal transplantation between 1997 and 2002. Inclusion criteria were patients who were not diabetic prior to transplantation and posttransplant follow-up longer than 6 months. DM was defined as fasting blood glucose levels higher than 126 mg/dL on at least two occasions. HCV infection was detected using second- or third-generation ELISA methods and/or polymerase chain reactions for HCV-RNA. Twenty-five HCV positive (HCV+) patients were compared with 25 consecutive HCV negative (HCV-) transplant patients. Demographic and clinical data of the groups were compared. Posttransplantation DM was observed in 24% of the HCV+ patients. There were no statistical differences in age, gender, race, family history of DM, follow-up, or body mass index between the two groups. There was a higher prevalence of posttransplantation DM in HCV+ patients, but the difference did not reach statistical significance (24% vs 12%, P = NS). Alternatively, comparing patients of the two groups (n = 50) who did versus not develop DM, the incidence of posttransplantation DM was higher among HCV+ patients, but the difference did not reach statistical significance (66.6% vs 46.3%, P = NS). In conclusion, there was no association between HCV infection and the development of posttransplantation DM in this cohort of renal transplant recipients. However, there was a trend that suggested an association.
Asunto(s)
Diabetes Mellitus/virología , Hepatitis C/complicaciones , Trasplante de Riñón/efectos adversos , Adulto , Brasil , Creatinina/sangre , Ciclosporina/uso terapéutico , Diabetes Mellitus/epidemiología , Femenino , Humanos , Inmunosupresores/uso terapéutico , Masculino , Prednisona/uso terapéutico , Grupos Raciales , Estudios Retrospectivos , Tacrolimus/uso terapéuticoAsunto(s)
Trasplante de Riñón/fisiología , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Adulto , Biopsia , Ciclosporina/efectos adversos , Diagnóstico Diferencial , Femenino , Rechazo de Injerto/diagnóstico por imagen , Rechazo de Injerto/patología , Humanos , Inmunosupresores/efectos adversos , Trasplante de Riñón/patología , Necrosis Tubular Aguda/diagnóstico por imagen , Necrosis Tubular Aguda/patología , Masculino , Complicaciones Posoperatorias/patología , Estudios RetrospectivosRESUMEN
The frequency of infection by Cryptosporidium parvum was determined in two groups of renal patients submitted to immunosuppression. One group consisted of 23 renal transplanted individuals, and the other consisted of 32 patients with chronic renal insufficiency, periodically submitted to hemodialysis. A third group of 27 patients with systemic arterial hypertension, not immunosuppressed, was used as control. During a period of 18 months all the patients were submitted to faecal examination to detect C. parvum oocysts, for a total of 1 to 6 tests per patient. The results showed frequencies of C. parvum infection of 34.8%, 25% and 17.4%, respectively, for the renal transplanted group, the patients submitted to hemodialysis and the control group. Statistical analysis showed no significant differences among the three groups even though the frequency of C. parvum infection was higher in the transplanted group. However, when the number of fecal samples containing C. parvum oocysts was taken in account, a significantly higher frequency was found in the renal transplanted group.
Asunto(s)
Criptosporidiosis/parasitología , Cryptosporidium parvum , Fallo Renal Crónico/parasitología , Trasplante de Riñón , Diálisis Renal , Animales , Criptosporidiosis/epidemiología , Cryptosporidium parvum/aislamiento & purificación , Heces/parasitología , Femenino , Humanos , Hipertensión/parasitología , Terapia de Inmunosupresión , Incidencia , Fallo Renal Crónico/terapia , MasculinoRESUMEN
Hemolytic uremic syndrome is characterized by the simultaneous occurrence of hemolytic anemia, thrombocytopenia, and renal failure. Clinical/ pathologic data, along with the treatment and outcome of 8 adult patients with HUS, are described. There were 7 females and 1 male, age 30.7 +/- 12 years; 7 were White and 1 Black. Three patients were kidney graft recipients, 2 of whom were receiving cyclosporine; 2 patients were postpartum; 1 case followed an abortion; 1 occurred with prodromic infection; and 1 case was without a causal factor. All patients presented with hematuria and 6 with oligoanuria. Laboratory data showed hemolytic anemia with schistocytes, LDH values were 2584 +/- 2191 U/L, platelets were 79,000 +/- 40,000/mL, creatinine concentrations were 5.9 +/- 2.5 mg/dL. Renal biopsy showed thrombotic microangiopathy. Two had predominant glomerular involvement. 2 showed renal cortical necrosis, 4 were marked by predominant arteriolar involvement. In 5 patients dialytic therapy was performed. All were treated with fresh-frozen plasma infusion and 6 with plasmapheresis. Three patients died, 2 without recovery of renal function. In conclusion, the trigger events were related to renal transplant in 3.2 of them taking cyclosporine; 3 with pregnancy; 1 to precedent infection; and 1 with no causal factor. There was no correlation between histological form and outcome in this group of patients. The benefit of plasmapheresis was evident in the recovery of the extrarenal manifestations, although it did not change the renal outcome. The prognosis is poor, with a high mortality (37.5%) and/or end-stage renal failure (37.5%). Complete recovery of renal function was obtained in 25%.
Asunto(s)
Lesión Renal Aguda/etiología , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/diagnóstico , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/terapia , Adolescente , Adulto , Biopsia con Aguja , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Síndrome Hemolítico-Urémico/fisiopatología , Humanos , Pruebas de Función Renal , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Plasmaféresis , Embarazo , Pronóstico , Tasa de SupervivenciaRESUMEN
Säo apresentados onze casos de pacientes receptores de transplante renal, nos quais houve desenvolvimento de septicemia por Salmonellas, sendo que em oito vezes a espécie isolada foi a enteritidis, em um caso a espécie dublin, noutro a newport, e noutro a choleraesuis. O quadro predominante foi o de febre (100//), havendo acometimento vascular associado em cinco casos (45//). Apenas um paciente evoluiu para óbito. Num dos pacientes houve crescimentode Salmonella enteritidis em cálculo biliar. Nove dos pacientes receberam esquema imunossupressor com azatioprina e prednisona e dois, com azatioprina, prednisona e ciclosporina
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Trasplante de Riñón/efectos adversos , Infecciones por Salmonella/complicaciones , Sepsis/etiologíaRESUMEN
Säo apresentados onze casos de pacientes receptores de transplante renal nos quais houve desenvolvimento de septicemia por Salmonellas, sendo que em oito vezex a espécie isolada foi a enteritidis, em um caso a espécie dublin, noutro a newport, e noutro a choleraesuis. O quadro predominante foi o de febre (100%), havendo acometimento vascular associado em cinco casos (45%), infecçäo do trato urinário em dois casos (18%), hepatite crônica ativa em dois casos (18%) e de articulaçäo sacroilíaca em um caso (9%). A creatinina estava maior que 2mg% em cinco casos (45%). Apenas um evoluiu para óbito. Num dos pacientes houve crescimento de Salmonella enteritidis em cálculo biliar. Nove dos pacientes receberam esquema imunossupressor com azatioprina e prednisona e dois com azatioprina, prednisona e ciclosporina