RESUMO
Hepatitis E virus (HEV) infection can be responsible for chronic hepatitis in immunocompromised patients, and can rapidly evolve into fibrosis and/or hepatic cirrhosis. We present two cases of chronic hepatitis E, emphasizing the need to be aware of this entity as a growing etiology of hepatitis in transplant and immunocompromised patients.
Assuntos
Hepatite E/diagnóstico , Hepatite Crônica/diagnóstico , Transplante de Rim/efeitos adversos , Transplantados , Biópsia , Análise por Conglomerados , Hepatite E/patologia , Vírus da Hepatite E/classificação , Vírus da Hepatite E/genética , Vírus da Hepatite E/isolamento & purificação , Hepatite Crônica/patologia , Histocitoquímica , Humanos , Fígado/patologia , Masculino , Microscopia , Pessoa de Meia-Idade , Filogenia , Portugal , Análise de Sequência de DNARESUMO
Diabetes currently accounts for approximately 45% of cases of end-stage renal failure in patients undergoing hemodialysis. Several observational studies have identified a positive correlation between measures of glycemic control and cardiovascular and microvascular benefits. Several randomized prospective studies have been conducted to quantify the impact of strict glycemic control on morbidity and mortality. These studies have consistently demonstrated an association between strict glycemic control and a reduction in microvascular events, but these results contrast with the lack of consistent results regarding macrovascular events. Treating diabetes has always been challenging. This challenge is increased in chronic kidney disease, due to changes in the pharmacokinetics and pharmacodynamics of insulin and most oral antidiabetic agents. The available pharmacotherapeutic arsenal for treating type 2 diabetes mellitus currently involves approximately 6 different pharmacological classes of oral antidiabetic agents and different modalities of insulin therapy.
