RESUMO
BACKGROUND: Urine monitoring programs represent an important strategy for early diagnosis of reactivation of BK polyomavirus (BKV) in kidney transplant recipients. This study analyzes a BKV urine screening model in kidney transplant patients. METHODS: Urinary screening for BKV reactivation was performed by urinary decoy cell and polymerase chain reaction (PCR) tests in samples from 32 consecutive kidney transplant patients, collected in a 6-month follow-up period. PCR in plasma samples and BKV immunohistochemical studies to assess BKV renal disease, if a kidney biopsy was indicated, were performed. RESULTS: The urinary screening for BKV among 32 renal receptors was positive in 18 patients (56%) by the concomitant use of the decoy cells and/or qualitative PCR at some time during the study period. Transfusion before transplantation was significantly associated with urinary decoy cell positive screening (odds ratio = 11; 95% confidence interval = 1.47 to 82.4; P < .05); and so was male sex (odds ratio = 2.02; 95% confidence interval = 1.07 to 3.83; P < .05). The clinical management of screening positive cases consisted of decreasing or changing the immunosuppression regimen. Sixteen renal biopsies were performed. Immunohistochemistry for SV40 T antigen was negative in all biopsies. After 1 year of follow-up, no patient developed BKV-associated nephropathy, and there was no difference in renal function between patients positive and negative for BKV urinary screening. CONCLUSIONS: Early urinary monitoring is effective in detection of BKV replication and represents a good strategy to minimize the deleterious effects caused by the presence of the virus on preservation of graft function.
Assuntos
DNA Viral/urina , Nefropatias/urina , Transplante de Rim , Infecções por Polyomavirus/urina , Infecções Tumorais por Vírus/urina , Adulto , Vírus BK/genética , Biópsia , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Imuno-Histoquímica , Imunossupressores/efeitos adversos , Nefropatias/diagnóstico , Nefropatias/etiologia , Nefropatias/patologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Reação em Cadeia da Polimerase , Infecções por Polyomavirus/diagnóstico , Infecções por Polyomavirus/etiologia , Fatores Sexuais , Transplantados , Infecções Tumorais por Vírus/diagnóstico , Infecções Tumorais por Vírus/etiologia , UrináliseAssuntos
Artrogripose/genética , Colestase Intra-Hepática/genética , Nefropatias/genética , Mutação/genética , Medição da Translucência Nucal , Proteínas de Transporte Vesicular/genética , Artrogripose/diagnóstico por imagem , Colestase Intra-Hepática/diagnóstico por imagem , Homozigoto , Humanos , Lactente , Nefropatias/diagnóstico por imagem , Túbulos Renais , Masculino , Portugal/etnologia , SíndromeAssuntos
Coloboma/genética , Rim/anormalidades , Nervo Óptico/anormalidades , Adolescente , Adulto , Idoso , Brasil , Criança , Pré-Escolar , Análise Mutacional de DNA , Proteínas de Ligação a DNA/genética , Feminino , Humanos , Masculino , Fator de Transcrição PAX2 , Linhagem , Diálise Peritoneal , Mutação Puntual , Reação em Cadeia da Polimerase , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Síndrome , Fatores de Transcrição/genéticaRESUMO
The neuronal ceroid lipofuscinoses (NCL) are a group of inherited progressive neurodegenerative disorders with presentation from infancy to adulthood. Three main childhood forms can be established on the basis of age of onset, clinical course, and ultrastructural morphology: infantile (INCL), late infantile (LINCL), and juvenile (JNCL). Several variant subtypes have been described. Genetic and biochemical analysis are helping to better understand, diagnose and classify these disorders. We report on clinical, neurophysiological, neuroradiological, and morphological data from 17 patients with different forms (infantile, late infantile, and juvenile ) of neuronal ceroid lipofuscinoses (NCL) evaluated at Hospital de Clínicas de Porto Alegre, Southern Brazil, during 6 years (1992-1997). Seven cases were infantile; 5 were late infantile; and 5 were juvenile NCL. Gender ratio was male:female, 11:6. Age at presentation varied from 2-24 months for INCL; 2,5 to 5 years for LINCL; and 4-10 years for the JNCL cases. Seizures (6 patients) and psychomotor retardation (1 patient) were the initial symptoms in the INCL group. All the patients in the group of LINCL had the usual findings. JNCL patients manifested different initial symptoms, although tending to follow a similar clinical picture within familial cases. Epidemiological data on the prevalence of NCLs in Brazil are not available, we expect this series of cases to contribute to further research in our population.
Assuntos
Lipofuscinoses Ceroides Neuronais/complicações , Adolescente , Adulto , Fatores Etários , Idade de Início , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Lipofuscinoses Ceroides Neuronais/genética , Lipofuscinoses Ceroides Neuronais/patologia , LinhagemRESUMO
The objective of this prospective multicenter study was to determine whether cisapride is associated with increased risk of malformations, spontaneous abortions, or decreased birthweight when used during pregnancy. Cases were paired for age, smoking, and alcohol consumption with controls exposed to nonteratogens, as well as with disease-paired controls. One hundred and twenty-nine pregnant women were exposed to cisapride during pregnancy, including 88 during the period of fetal organogenesis. There were no differences in maternal history, birthweight, gestational age at delivery, and rates of livebirths, spontaneous or therapeutic abortions, fetal distress, and major or minor malformations among groups. It is concluded that exposure to cisapride during pregnancy is not associated with a major increased risk of malformations or spontaneous abortions or with decreased birthweight.
