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1.
J. bras. nefrol ; 44(4): 527-532, Dec. 2022. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1421921

RESUMEN

Abstract Introduction: Sensitization to human leukocyte antigen is a barrier to. Few data have been published on desensitization using polyvalent human intravenous immunoglobulin (IVIG) alone. Methods: We retrospectively reviewed the of 45 patients with a positive complement-dependent cytotoxicity crossmatch (CDCXM) or flow cytometry crossmatch (FCXM) against living donors from January 2003 to December 2014. Of these, 12 were excluded. Patients received monthly IVIG infusions (2 g/kg) only until they had a negative T-cell and B-cell FCXM. Results: During the 33 patients, 22 (66.7%) underwent living donor kidney transplantation, 7 (21.2%) received a deceased donor graft, and 4 (12.1%) did not undergo transplantation. The median class I and II panel reactive antibodies for these patients were 80.5% (range 61%-95%) and 83.0% (range 42%-94%), respectively. Patients (81.8%) had a positive T-cell and/or B-cell CDCXM and 4 (18.2%) had a positive T-cell and/or B-cell FCXM. Patients underwent transplantation after a median of 6 (range 3-16). The median donor-specific antibody mean fluorescence intensity sum was 5057 (range 2246-11,691) before and 1389 (range 934-2492) after desensitization (p = 0.0001). Mean patient follow-up time after transplantation was 60.5 (SD, 36.8) months. Nine patients (45.0%). Death-censored graft survival at 1, 3, and 5 years after transplant was 86.4, 86.4, and 79.2%, respectively and patient survival was 95.5, 95.5, and 83.7%, respectively. Conclusions: Desensitization using IVIG alone is an effective strategy, allowing successful transplantation in 87.9% of these highly sensitized patients.


Resumo Introdução: Sensibilização HLA é uma barreira ao transplante em pacientes sensibilizados. Há poucos dados publicados sobre dessensibilização utilizando somente imunoglobulina intravenosa humana polivalente (IgIV). Métodos: Revisamos retrospectivamente prontuários de 45 pacientes com prova cruzada positiva por citotoxicidade dependente do complemento (CDCXM) ou citometria de fluxo (FCXM) contra doadores vivos, de Janeiro/2003-Dezembro/2014. Destes, excluímos 12. 33 pacientes receberam infusões mensais de IgIV (2 g/kg) apenas até apresentarem FCXM células T e B negativa. Resultados: Durante dessensibilização, 22 pacientes (66,7%) realizaram transplante renal com doador vivo, 7 (21,2%) receberam enxerto de doador falecido, 4 (12,1%) não realizaram transplante. A mediana do painel de reatividade de anticorpos classes I e II para estes pacientes foi 80,5% (intervalo 61%-95%) e 83,0% (intervalo 42%-94%), respectivamente. 18 pacientes (81,8%) apresentaram CDCXM célula T e/ou B positiva; 4 (18,2%) apresentaram FCXM célula T e/ou B positiva. Pacientes realizaram transplante após mediana de 6 (intervalo 3-16) infusões. A mediana da somatória da intensidade média de fluorescência do anticorpo específico contra o doador foi 5057 (intervalo 2246-11.691) antes e 1389 (intervalo 934-2492) após dessensibilização (p = 0,0001). O tempo médio de acompanhamento do paciente pós transplante foi 60,5 (DP, 36,8) meses. Nove pacientes (45,0%) não apresentaram rejeição e 6 (27,3%) apresentaram rejeição mediada por anticorpos. Sobrevida do enxerto censurada para óbito em 1, 3, 5 anos após transplante foi 86,4; 86,4; 79,2%, respectivamente, e sobrevida do paciente foi 95,5; 95,5; 83,7%, respectivamente. Conclusões: Dessensibilização utilizando apenas IgIV é uma estratégia eficaz, permitindo transplante bem-sucedido em 87,9% destes pacientes altamente sensibilizados.

2.
J Bras Nefrol ; 44(4): 527-532, 2022.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-35438714

RESUMEN

INTRODUCTION: Sensitization to human leukocyte antigen is a barrier to. Few data have been published on desensitization using polyvalent human intravenous immunoglobulin (IVIG) alone. METHODS: We retrospectively reviewed the of 45 patients with a positive complement-dependent cytotoxicity crossmatch (CDCXM) or flow cytometry crossmatch (FCXM) against living donors from January 2003 to December 2014. Of these, 12 were excluded. Patients received monthly IVIG infusions (2 g/kg) only until they had a negative T-cell and B-cell FCXM. RESULTS: During the 33 patients, 22 (66.7%) underwent living donor kidney transplantation, 7 (21.2%) received a deceased donor graft, and 4 (12.1%) did not undergo transplantation. The median class I and II panel reactive antibodies for these patients were 80.5% (range 61%-95%) and 83.0% (range 42%-94%), respectively. Patients (81.8%) had a positive T-cell and/or B-cell CDCXM and 4 (18.2%) had a positive T-cell and/or B-cell FCXM. Patients underwent transplantation after a median of 6 (range 3-16). The median donor-specific antibody mean fluorescence intensity sum was 5057 (range 2246-11,691) before and 1389 (range 934-2492) after desensitization (p = 0.0001). Mean patient follow-up time after transplantation was 60.5 (SD, 36.8) months. Nine patients (45.0%). Death-censored graft survival at 1, 3, and 5 years after transplant was 86.4, 86.4, and 79.2%, respectively and patient survival was 95.5, 95.5, and 83.7%, respectively. CONCLUSIONS: Desensitization using IVIG alone is an effective strategy, allowing successful transplantation in 87.9% of these highly sensitized patients.


Asunto(s)
Inmunoglobulinas Intravenosas , Trasplante de Riñón , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Donadores Vivos , Estudios Retrospectivos , Rechazo de Injerto/prevención & control , Anticuerpos , Supervivencia de Injerto
3.
J Bras Nefrol ; 42(2 suppl 1): 36-40, 2020 Aug 26.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32877497

RESUMEN

During the Covid-19 pandemic, the issue is how to maintain adequate care for people with other diseases. In this document, the SBN Rare Diseases Committee (COMDORA) gives some guidelines on the care of patients with rare kidney diseases. These patients should follow the recommendations for the general population, bearing in mind that, as they have chronic kidney disease, they are included in the risk group for more serious outcomes if they develop Covid-19. Non-essential decision-making procedures should be postponed. In stable cases under appropriate treatment, we must choose to contact our patients remotely, using teleconsultations and home exam collections (if possible). In the presence of a symptom or sign of decompensation of the underlying disease, or infection with Sars-cov-2, advise the patient to seek medical assistance. The patient should not be waiting to get worse. Changes to the prescription should only be made on a scientific basis. Dosage suspension or change is not recommended, even in cases in which the patient needs to go to a center to receive his medication; in this case, the infusion center must follow the recommendations of the Ministry of Health. If the patient develops Covid-19 and uses any drugs, check the need for dose adjustment of the routine medications. Avoid the use of antimetabolics and anti-CD20 in patients with Covid-19, as they reduce viral clearance and predispose to bacterial infections. Contact between the patient and the medical team is essential; changes are recommended only with specialized medical guidance.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedades Renales/terapia , Neumonía Viral/epidemiología , Enfermedades Raras/terapia , Brasil , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Interacciones Farmacológicas , Humanos , Pandemias , Aceptación de la Atención de Salud , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , SARS-CoV-2 , Evaluación de Síntomas
6.
Clin Dermatol ; 38(1): 35-41, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32197747

RESUMEN

A rash is a disseminated eruption of cutaneous lesions with great variation in appearance, cause, and severity. When the physician is facing a rash, the history and physical examination of the patient are extremely important for the identification of the disease and its causal agent. There are various causes for a rash, which may be infectious, allergic, or rheumatologic, besides many others. Rashes associated with mucosal ulcers may have causes related to viral and bacterial infections or drug reactions. They may be associated with measles; erythema infectiosum; roseola infantum; rubella; hand, foot, and mouth disease; pityriasis rosea; dengue fever; chikungunya; zika; scarlet fever; meningococcal diseases; syphilis; and exanthematous drug eruptions.


Asunto(s)
Infecciones Bacterianas/complicaciones , Exantema/etiología , Exantema/microbiología , Membrana Mucosa/patología , Úlcera/etiología , Úlcera/microbiología , Virosis/complicaciones , Infecciones Bacterianas/patología , Exantema/patología , Humanos , Úlcera/patología , Virosis/patología
7.
J. bras. nefrol ; 42(2,supl.1): 36-40, 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1134838

RESUMEN

ABSTRACT During the Covid-19 pandemic, the issue is how to maintain adequate care for people with other diseases. In this document, the SBN Rare Diseases Committee (COMDORA) gives some guidelines on the care of patients with rare kidney diseases. These patients should follow the recommendations for the general population, bearing in mind that, as they have chronic kidney disease, they are included in the risk group for more serious outcomes if they develop Covid-19. Non-essential decision-making procedures should be postponed. In stable cases under appropriate treatment, we must choose to contact our patients remotely, using teleconsultations and home exam collections (if possible). In the presence of a symptom or sign of decompensation of the underlying disease, or infection with Sars-cov-2, advise the patient to seek medical assistance. The patient should not be waiting to get worse. Changes to the prescription should only be made on a scientific basis. Dosage suspension or change is not recommended, even in cases in which the patient needs to go to a center to receive his medication; in this case, the infusion center must follow the recommendations of the Ministry of Health. If the patient develops Covid-19 and uses any drugs, check the need for dose adjustment of the routine medications. Avoid the use of antimetabolics and anti-CD20 in patients with Covid-19, as they reduce viral clearance and predispose to bacterial infections. Contact between the patient and the medical team is essential; changes are recommended only with specialized medical guidance.


RESUMO Durante a pandemia da Covid-19, fica a questão de como manter o atendimento adequado aos portadores de outras doenças. O Comitê de Doenças Raras (COMDORA) da SBN neste documento dá algumas orientações ao atendimento de pacientes com doenças renais raras. Estes pacientes devem seguir as recomendações destinadas à população geral tendo em mente que, por serem portadores de doença renal crônica, estão incluídos no grupo de risco para desfechos mais graves, caso venham a desenvolver a Covid-19. Procedimentos não essenciais para tomada de decisão devem ser adiados. Deve-se optar por contatos a distância, como teleconsultas, e coletas de exames domiciliares (se possível) nos casos estáveis sob tratamento adequado. Na presença de sintoma ou sinal de descompensação da doença de base ou infecção pelo Sars-cov-2, orientar o paciente a procurar a equipe médica. O paciente não deve ficar esperando o quadro agravar-se. Alterações na prescrição só devem ser feitas com embasamento científico. Não se recomenda a suspensão ou alteração posológica, mesmo nos casos em que o paciente necessita ir a um centro para receber sua medicação; neste caso o centro de infusão deve seguir as recomendações do Ministério da Saúde. Caso o paciente desenvolva a Covid-19 e faça uso de alguma droga, verificar a necessidade de ajuste nas doses dos medicamentos rotineiros. Evitar o uso de antimetabólicos e antiCD20 nos pacientes com a Covid-9, por reduzirem o clareamento viral e predisporem a infecções bacterianas. O contato entre paciente e equipe médica é essencial; alterações são recomendadas apenas com orientação médica especializada.


Asunto(s)
Humanos , Neumonía Viral/epidemiología , Enfermedades Raras/terapia , Betacoronavirus , Enfermedades Renales/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Brasil , Aceptación de la Atención de Salud , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Interacciones Farmacológicas , Pandemias , Evaluación de Síntomas , SARS-CoV-2 , COVID-19
8.
Clin Dermatol ; 36(2): 188-196, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29566923

RESUMEN

Dermatologists must be familiar with the peculiarities of the micro-organisms that may affect the elderly, in order to optimize the diagnosis and treatment of infections, which may affect their skin, especially because the world population is rapidly aging. It is estimated that there will be 434 million individuals over 80 years of age in 2050. Since the elderly population is rapidly increasing and their infections are usually more severe and different from those observed in younger adults, it leads to a statistical increase of the rates regarding hospitalization and mortality caused by infectious diseases among people over 85 years. Other health issues may be involved in the older population. These include nutritional alterations, as malnutrition or obesity, which can aggravate the infections. Also the usual signs and symptoms of infection are subtle or uncharacteristic in elderly patients, and frequently, they are unable to report their symptoms, which can delay the diagnosis. Among the many infections that may affect the elderly we reviewed the most frequent and those that are different in this age group, as herpes zoster, cytomegalovirus, herpes simplex, bacterial skin infections, erysipelas, celullitis, impetigo, folliculitis, furunculosis and carbunculosis, secondary infections, intertrigo (body folds), fungal infection, and scabies.


Asunto(s)
Herpes Zóster/prevención & control , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/microbiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Antivirales/uso terapéutico , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Dermatomicosis/diagnóstico , Dermatomicosis/microbiología , Erisipela/diagnóstico , Foliculitis/tratamiento farmacológico , Foliculitis/microbiología , Herpes Zóster/tratamiento farmacológico , Humanos , Intertrigo/microbiología , Persona de Mediana Edad , Escabiosis/diagnóstico , Escabiosis/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/diagnóstico , Enfermedades Cutáneas Infecciosas/virología
9.
J. bras. nefrol ; 37(2): 228-240, Apr-Jun/2015. tab, graf
Artículo en Portugués | LILACS | ID: lil-751448

RESUMEN

Resumo A combinação de imunossupressores faz parte do protocolo de tratamento de pacientes submetidos a um transplante renal (TR). A Thymoglobuline®, imunoglobulina policlonal de coelho dirigida contra timócitos humanos, é o agente mais usado como terapia de indução no TR nos Estados Unidos. No Brasil, a Thymoglobuline® está aprovada para uso em pacientes que foram submetidos a transplante e, apesar de ser amplamente utilizada, ainda existem controvérsias em relação ao seu modo de uso. Realizamos uma revisão sistemática da literatura avaliando os estudos que utilizaram a Thymoglobuline® na indução e no tratamento de rejeição em pacientes submetidos ao TR. A revisão utilizou os bancos de dados computadorizados da EMBASE, LILACS e MedLine e dos trabalhos selecionados foram extraídas informações sobre os dados gerais dos pacientes, as características metodológicas e as variáveis analisadas em cada estudo. Dos resultados obtidos, desenvolvemos um guia prático sobre o uso de Thymoglobuline® em pacientes transplantados renais.


Abstract The combination of immunosuppressive drugs is part of the treatment regimen of patients undergoing kidney transplantation (RT). Thymoglobulin®, a rabbit immunoglobulin directed against human thymocytes, is the most commonly agent used for induction therapy in RT in the US. In Brazil, Thymoglobulin® is approved by ANVISA for the use in patients who underwent kidney transplantation and despite being widely used, there are controversies regarding the drug administration. We prepared a systematic review of the literature, evaluating studies that used Thymoglobulin® for induction and for acute rejection treatment in patients undergoing RT. The review used the computadorized databases of EMBASE, LILACS and MedLine. Data were extracted from the studies concerning general features, methodological characteristics and variables analyzed in each study. From the results, a practical guide was prepared analyzing various aspects on the use of Thymoglobulin® in patients submitted to RT.


Asunto(s)
Humanos , Suero Antilinfocítico/uso terapéutico , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/prevención & control , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Guías de Práctica Clínica como Asunto
11.
Clinics ; 67(12): 1365-1371, Dec. 2012. ilus, tab
Artículo en Inglés | LILACS | ID: lil-660462

RESUMEN

OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation. METHODS: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2). The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was 36.7% in Phase 1 and 38.3% in Phase 2 of the study. RESULTS: There were no significant differences between patients with and without changes in sleep quality between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2. CONCLUSION: Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Trasplante de Riñón/fisiología , Trastornos del Sueño-Vigilia/epidemiología , Sueño/fisiología , Métodos Epidemiológicos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/psicología , Trastornos del Sueño-Vigilia/diagnóstico , Factores de Tiempo
12.
Clinics (Sao Paulo) ; 67(12): 1365-71, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23295588

RESUMEN

OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation. METHODS: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2). The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was 36.7% in Phase 1 and 38.3% in Phase 2 of the study. RESULTS: There were no significant differences between patients with and without changes in sleep quality between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2. CONCLUSION: Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.


Asunto(s)
Trasplante de Riñón/fisiología , Trastornos del Sueño-Vigilia/epidemiología , Sueño/fisiología , Adulto , Métodos Epidemiológicos , Femenino , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/psicología , Masculino , Trastornos del Sueño-Vigilia/diagnóstico , Factores de Tiempo
15.
Rio de Janeiro; Atheneu; 2009. 1215 p. ilus, tab.
Monografía en Portugués | LILACS, AHM-Acervo, CAMPOLIMPO-Acervo | ID: lil-653014
18.
An. bras. dermatol ; 78(1): 79-85, jan.-fev. 2003. ilus
Artículo en Portugués, Inglés | LILACS | ID: lil-341611

RESUMEN

Os autores apresentam dois casos de hiperplasia angiolinfóide com eosinofilia, doença relativamente rara. Uma das pacientes apresentava lesões exuberantes e de localização incomum, já que é em geral situada na cabeça e/ou no pescoço. A histopatologia corada com HE e a imuno-histoquímica com fator VIII confirmaram o diagnóstico e a origem endotelial das lesões de ambas as pacientes


Asunto(s)
Humanos , Femenino , Adulto , Hiperplasia Angiolinfoide con Eosinofilia , Eosinofilia
19.
An. paul. med. cir ; 129(3): 70-72, jul.-set. 2002.
Artículo en Portugués | LILACS | ID: lil-391394

RESUMEN

É descrito o caso de um paciente que recebeu um rim do seu irmão HLA idêntido e que, voluntariamente e alegando razões religiosas, suspendeu totalmente a imunossupressão e, apesar disto, teve boa evolução do enxerto. O paciente está hoje, 12 anos pós-transplante e 7 anos e 6 meses após a suspensão da imunossupressão, com função renal normal


Asunto(s)
Humanos , Masculino , Adulto , Trasplante de Riñón , Inmunosupresores
20.
An. paul. med. cir ; 129(1): 20-23, jan.-mar. 2002. ilus
Artículo en Portugués | LILACS | ID: lil-319586

RESUMEN

Descrevemos o caso de um paciente que recebeu rim de doador cadavérico e desenvolveu hipertensäo arterial acentuada no pós-transplante. Estudo ultrasonográfico com doppler foi sugestivo de estenose da artéria renal, confirmada por angiografia digital que mostrou sinais característicos de displasia fibromuscular. Foi realizada angioplastia transluminal com sucesso, permitindo o controle da pressäo arterial com doses baixas de drogas anti-hipertensivas


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Displasia Fibromuscular , Hipertensión Renovascular/etiología , Trasplante de Riñón , Angioplastia de Balón , Hipertensión Renovascular/terapia
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