Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 48
Filtrar
Mais filtros

País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
J Ren Nutr ; 33(5): 649-656, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37178773

RESUMO

OBJECTIVE: In subjects with chronic kidney disease (CKD), the effect of low-protein diet (LPD) is expected to alleviate uremic symptoms. However, whether LPD is effective in preventing loss of kidney function is controversial. The aim of this study was to evaluate the association between LPD and renal outcomes. METHODS: We conducted a multicenter cohort study of 325 patients who suffered CKD stage 4 and 5 with eGFR ≥10 mL/min/1.73 m,2 between January 2008 and December 2014. The primary diseases of the patients were chronic glomerulonephritis (47.7%), nephrosclerosis (16.9%), diabetic nephropathy (26.2%), and others (9.2%). The patients were divided into four groups, based on the mean protein intake (PI)/day, group 1 (n = 76): PI < 0.5 g/kg ideal body weight/day, group 2 (n = 56): 0.5 ≤ PI < 0.6 g/kg/day, group 3 (n = 110): 0.6 ≤ PI < 0.8 g/kg/day, group 4 (n = 83): PI ≥ 0.8 g/kg/day. Dietary supplementation with essential amino acids and ketoanalogues was not used. The outcome measure was occurrence of renal replacement therapy (RRT) (hemodialysis, peritoneal dialysis, renal transplantation (excluding preemptive transplantation)) and all-cause mortality until December 2018. Cox regression models were used to examine whether LPD was associated with the risk of outcomes. RESULTS: During a mean follow-up of 4.1 ± 2.2 years. Thirty-three patients (10.2%) died of all causes, 163 patients (50.2%) needed to start RRT, and 6 patients (1.8%) received a renal transplant. LPD therapy of 0.5 g/kg/day or less was significantly related to a lower risk of RRT and all-cause mortality [Hazard ratio = 0.656; 95% confidence interval, 0.438 to 0.984, P = .042]. CONCLUSIONS: These results suggest that non-supplemented LPD therapy of 0.5 g/kg/day or less may prolong the initiation of RRT in stage 4 and 5 CKD patients.


Assuntos
Dieta com Restrição de Proteínas , Insuficiência Renal Crônica , Humanos , Japão , Estudos de Coortes , Progressão da Doença , Terapia de Substituição Renal
2.
BMC Nephrol ; 22(1): 230, 2021 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-34147067

RESUMO

BACKGROUND: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Although most IgAN cases are sporadic, few show a familial aggregation. However, the prevalence and prognosis of IgAN individuals with positive familial history (FH) of renal disorders remains uncertain. To address these issues, we conducted a longitudinal observational study on a single-institution cohort of patients with biopsy-proven IgAN. METHODS: A total of 467 IgAN patients who underwent renal biopsy during 1994 to 2019 were ascertained to have positive- or negative-FH by history taking and were followed for an average of 8.9 years. We compared the clinical and pathological features of the two subgroups. The primary outcome, a composite of a hard endpoint (end-stage renal disease [ESRD]) and surrogate endpoint (a 50% or more reduction in the estimated glomerular filtration rate [eGFR] from baseline), was evaluated. To estimate the risk for progression to ESRD, a Cox proportional hazards analysis was performed for a subset of patients who underwent follow-up for > 2 years and had an eGFR > 30 mL/min/1.73 m2 at baseline (n = 389; observation, 8.7 years). RESULTS: Positive-FH subtype accounted for 11.6% (n = 54) of all IgAN patients. At baseline, there were no significant differences between the positive- and negative-FH subgroups regarding age, sex, comorbid disease, MEST-C score, observation period, and therapeutic interventions. However, the eGFR value at baselines was significantly lower in the positive-FH subgroup than in the negative-FH subgroup (P < 0.01). On multivariate analysis, positive-FH emerged an independent determinant of poorer renal outcomes (odds ratio, 2.31; 95% confidence interval, 1.10-4.85; P = 0.03), after adjusting for confounding factors. eGFR at follow-up was significantly lower in the positive-FH subgroup than in the negative-FH subgroup after adjustment for age and observation period. CONCLUSIONS: Positive-FH was found in 11.6% of all IgAN patients, consistent with the incidence seen in previous literature. A significantly lower eGFR at baseline and last follow-up and unfavorable renal outcomes in the positive-FH subgroup suggest that certain genetic risk factors predisposing to renal failure may exist in a fraction of our IgAN cohort. (331 words).


Assuntos
Predisposição Genética para Doença , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/genética , Progressão da Doença , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/fisiopatologia , Humanos , Falência Renal Crônica/etiologia , Estudos Longitudinais , Prognóstico
3.
Kidney Int ; 98(2): 391-403, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32622525

RESUMO

Focal segmental glomerulosclerosis (FSGS) is a common cause of steroid-resistant nephrotic syndrome. Spontaneous remission of FSGS is rare and steroid-resistant FSGS frequently progresses to renal failure. Many inheritable forms of FSGS have been described, caused by mutations in proteins that are important for podocyte function. Here, we show that a basic leucine zipper transcription factor, MafB, protects against FSGS. MAFB expression was found to be decreased in the podocytes of patients with FSGS. Moreover, conditional podocyte-specific MafB-knockout mice developed FSGS with massive proteinuria accompanied by depletion of the slit diaphragm-related proteins (Nphs1 and Magi2), and the podocyte-specific transcription factor Tcf21. These findings indicate that MafB plays a crucial role in the pathogenesis of FSGS. Consistent with this, adriamycin-induced FSGS and attendant proteinuria were ameliorated by MafB overexpression in the podocytes of MafB podocyte-specific transgenic mice. Thus, MafB could be a new therapeutic target for FSGS.


Assuntos
Glomerulosclerose Segmentar e Focal , Síndrome Nefrótica , Podócitos , Animais , Fatores de Transcrição Hélice-Alça-Hélice Básicos , Glomerulosclerose Segmentar e Focal/genética , Humanos , Fator de Transcrição MafB/genética , Camundongos , Camundongos Transgênicos , Síndrome Nefrótica/genética , Proteinúria/genética , Proteinúria/prevenção & controle
4.
Kidney Int ; 94(2): 396-407, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29779709

RESUMO

Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage renal disease in children and adults. Genetic factors significantly contribute to early-onset FSGS, but the etiologies of most adult cases remain unknown. Genetic studies of monogenic syndromic FSGS exhibiting extra-renal manifestations have uncovered an unexpected biological role for genes in the development of both podocytes and other cellular lineages. To help define these roles, we studied two unrelated families with FSGS associated with Duane Retraction Syndrome, characterized by impaired horizontal eye movement due to cranial nerve malformation. All four affected individuals developed FSGS and Duane Retraction Syndrome in their first to second decade of life, manifested as restricted abduction together with globe retraction and narrowed palpebral fissure on attempted adduction. Hypoplasia of the abducens nerves and hearing impairment occurred in severely affected individuals. Genetic analyses revealed that affected individuals harbor a rare heterozygous substitution (p.Leu239Pro) in MAFB, a leucine zipper transcription factor. Luciferase assays with cultured monocytes indicated that the substitution significantly reduced transactivation of the F4/80 promoter, the known MAFB recognition element. Additionally, immunohistochemistry indicated reduced MAFB expression in the podocytes of patients. Structural modeling suggested that the p.Leu239Pro substitution in the DNA-binding domain possibly interferes with the stability of the adjacent zinc finger. Lastly, podocytes in neonatal mice with p.Leu239Pro displayed impaired differentiation. Thus, MAFB mutations impair development and/or maintenance of podocytes, abducens neurons and the inner ear. The interactions between MAFB and regulatory elements in these developing organs are likely highly specific based on spatiotemporal requirements.


Assuntos
Síndrome da Retração Ocular/etiologia , Glomerulosclerose Segmentar e Focal/genética , Falência Renal Crônica/etiologia , Fator de Transcrição MafB/genética , Adolescente , Adulto , Idade de Início , Substituição de Aminoácidos , Animais , Criança , Síndrome da Retração Ocular/patologia , Feminino , Testes Genéticos , Glomerulosclerose Segmentar e Focal/complicações , Glomerulosclerose Segmentar e Focal/patologia , Heterozigoto , Humanos , Falência Renal Crônica/patologia , Masculino , Camundongos , Mutação , Podócitos/patologia , Domínios Proteicos/genética , Homologia de Sequência de Aminoácidos , Adulto Jovem
5.
Clin Exp Nephrol ; 21(6): 961-970, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27783276

RESUMO

BACKGROUND: We designed a prospective and randomized trial of mizoribine (MZR) therapy combined with prednisolone (PSL) for idiopathic membranous nephropathy (IMN) with steroid-resistant nephrotic syndrome (SRNS). METHODS: Patients with IMN were divided into 2 groups, and MZR combined with PSL was administered for 2 years. PSL was initially prescribed at 40 mg/day and tapered. MZR was given once-a-day at 150 mg and 3-times-a-day at 50 mg each to groups 1 and 2. Serum MZR concentrations from 0 to 4 h after administration were examined within one month of treatment. The concentration curve and peak serum level (C max) of MZR were estimated by the population pharmacokinetic (PPK) parameters of MZR. RESULTS: At 2 years, 10 of 19 patients (52.6 %) in group 1 and 7 of 18 patients (38.9 %) in group 2 achieved complete remission (CR). The time-to-remission curve using the Kaplan-Meier technique revealed an increase in the cumulative CR rate in group 1, but no significant difference between the groups. Meanwhile, there was a significant difference in C max between groups 1 and 2 (mean ± SD: 1.20 ± 0.52 vs. 0.76 ± 0.39 µg/mL, p = 0.04), and C max levels in CR cases were significantly higher than those in non-CR cases. Receiver operating characteristic analysis showed that C max more than 1.1 µg/mL was necessary for CR in once-a-day administration. CONCLUSION: Administration of MZR once a day is useful when combined with PSL for treatment of IMN with SRNS. In addition, it is important to assay the serum concentration of MZR and to determine C max, and more than 1.1 µg/mL of C max is necessary for CR.


Assuntos
Glomerulonefrite Membranosa/tratamento farmacológico , Imunossupressores/administração & dosagem , Síndrome Nefrótica/tratamento farmacológico , Ribonucleosídeos/administração & dosagem , Adulto , Idoso , Feminino , Glomerulonefrite Membranosa/complicações , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/sangue , Imunossupressores/farmacocinética , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/etiologia , Prednisolona/administração & dosagem , Estudos Prospectivos , Ribonucleosídeos/sangue , Ribonucleosídeos/farmacocinética
6.
Mod Rheumatol ; 27(5): 898-900, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25867227

RESUMO

Relapsing polychondritis (RP) is a rare systemic autoimmune disorder characterized by the episodic and progressive deterioration of cartilage inflammation. Approximately 30% patients with RP have concurrent disease. However, there have been no previous reports of RP complicated by immunoglobulin G4-related disease (IgG4-RD). Here we report the case of a 67-year-old male who developed IgG4-RD approximately 20 years after RP diagnosis. The association between IgG4-RD and RP remains unclear.


Assuntos
Hipergamaglobulinemia , Imunoglobulina G/imunologia , Policondrite Recidivante/complicações , Idoso , Cartilagem/patologia , Humanos , Hipergamaglobulinemia/diagnóstico , Hipergamaglobulinemia/etiologia , Inflamação , Masculino , Radiografia/métodos
7.
Nephrology (Carlton) ; 21(10): 887-92, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26603689

RESUMO

AIM: Acute kidney injury (AKI) is a common complication of minimal change nephrotic syndrome (MCNS), particularly in adults. We evaluated the prevalence of AKI at the onset of adult MCNS and analyzed the influence of AKI on the duration of achieving complete remission (CR). METHODS: A retrospective, single-centre, dynamic cohort study was conducted with biopsy-proven, first-onset, adult MCNS patients treated with corticosteroids. Fifty-three consecutive patients diagnosed with MCNS from January 2000 to April 2014 were enrolled. Age, gender, daily urinary protein excretion, and serum creatinine levels were measured. To evaluate AKI during induction, we used the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI and judged AKI stage according to the fluctuations in serum creatinine levels during the first 4 weeks of starting corticosteroid therapy. RESULTS: Twenty patients (37.7%) met the AKI criteria and all 53 patients achieved CR within 1 year. Kaplan-Meier analysis showed that the median time to CR was significantly longer in patients with AKI than in patients without AKI. Cox proportional hazard analysis showed that the hazard ratio (HR) associated with the presence of AKI for achieving CR within 4 weeks was 0.36 after adjustment for age, gender, serum albumin, daily urinary protein excretion, hypertension, administration of 25% albumin, and methylprednisolone pulse therapy. A graded association was also observed between AKI stage and HR for achieving CR. CONCLUSIONS: The prevalence of AKI is high in adult patients with MCNS during induction therapy. AKI is an independent factor that delays the time to CR.


Assuntos
Injúria Renal Aguda , Creatinina/análise , Glucocorticoides/uso terapêutico , Nefrose Lipoide , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/fisiopatologia , Adolescente , Adulto , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/diagnóstico , Nefrose Lipoide/epidemiologia , Nefrose Lipoide/fisiopatologia , Nefrose Lipoide/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Prevalência , Indução de Remissão/métodos
8.
Acta Derm Venereol ; 95(7): 826-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25633161

RESUMO

We report a 68-year-old Japanese female patient with subepidermal blistering disease with autoantibodies to multiple laminins, who subsequently developed membranous glomerulonephropathy. At skin disease stage, immunofluorescence demonstrated IgG anti-basement membrane zone antibodies reactive with dermal side of NaCl-split skin. Immunoblotting of human dermal extract, purified laminin-332, hemidesmosome-rich fraction and laminin-521 trimer recombinant protein (RP) detected laminin γ-1 and α-3 and γ-2 subunits of laminin-332. Three years after skin lesions disappeared, nephrotic symptoms developed. Antibodies to α-3 chain of type IV collagen (COL4A3) were negative, thus excluding the diagnosis of Goodpasture syndrome. All anti-laminin antibodies disappeared. Additional IB and ELISA studies of RPs of various COL4 chains revealed reactivity with COL4A5, but not with COL4A6 or COL4A3. Although diagnosis of anti-laminin γ-1 (p200) pemphigoid or anti-laminin-332-type mucous membrane pemphigoid could not be made, this case was similar to previous cases with autoantibodies to COL4A5 and/or COL4A6.


Assuntos
Autoanticorpos/análise , Doenças Autoimunes/imunologia , Vesícula/imunologia , Colágeno Tipo IV/imunologia , Glomerulonefrite Membranosa/imunologia , Rim/imunologia , Laminina/imunologia , Pele/imunologia , Idoso , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Biópsia , Vesícula/sangue , Vesícula/diagnóstico , Vesícula/terapia , Feminino , Imunofluorescência , Glomerulonefrite Membranosa/sangue , Glomerulonefrite Membranosa/diagnóstico , Glucocorticoides/uso terapêutico , Humanos , Rim/ultraestrutura , Troca Plasmática , Valor Preditivo dos Testes , Subunidades Proteicas , Pele/efeitos dos fármacos , Pele/patologia , Fatores de Tempo
9.
Clin Exp Nephrol ; 19(4): 646-52, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25376866

RESUMO

BACKGROUND: In 2011, the Japanese Society of Nephrology (JSN) published new clinical guidelines for IgA nephropathy (IgAN) with a new risk stratification based on clinical and histological severity. For classification, patients are divided into four groups (low, medium, high, and very high risk). However, differences in responsiveness to each treatment among different groups remain unclear. We evaluate the responsiveness of tonsillectomy plus steroid pulse (TSP) therapy using the new risk stratification. METHODS: We retrospectively reviewed 111 IgAN patients with TSP therapy between January 2003 and January 2013. Study patients were divided into three groups [low- (n = 40), medium- (n = 43) and high-/very high-risk group (n = 28)]. The primary outcome was clinical remission (CR). The observation period was 1 year following tonsillectomy. RESULTS: 57 out of 111 patients (51.4 %) reached CR. The CR incidence was 70.0, 41.9 and 39.3 % (the low-, the medium- and the high-/very high-risk group, respectively). The incidence of CR was significantly higher in the low-risk group (P = 0.013). In a multivariate logistic regression analysis, both the medium- and the high-/very high-risk group showed significantly lower incidence of inducing CR than the low-risk group [(odds ratio 0.324; 95 % confidence interval 0.106-0.939, P = 0.041) (odds ratio 0.239; 95 % confidence interval 0.058-0.910, P = 0.040), respectively]. CONCLUSIONS: The new risk stratification in the 2011 JSN clinical guidelines for IgAN had a positive impact on early CR of TSP therapy.


Assuntos
Glomerulonefrite por IGA/tratamento farmacológico , Glomerulonefrite por IGA/cirurgia , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Tonsilectomia , Adulto , Feminino , Glomerulonefrite por IGA/epidemiologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Indução de Remissão , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
10.
Clin Exp Nephrol ; 18(5): 784-94, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24363128

RESUMO

BACKGROUND: Combined treatment with cyclosporine microemulsion preconcentrate (CyA MEPC) and steroids has been widely used for idiopathic membranous nephropathy (IMN) associated with steroid-resistant nephrotic syndrome (SRNS). Recent studies have shown that once-a-day and preprandial administration of CyA MEPC is more advantageous than the conventional twice-a-day administration in achieving the target blood CyA concentration at 2 h post dose (C2). We designed a randomized trial to compare these administrations. METHODS: IMN patients with SRNS (age 16-75 years) were divided prospectively and randomly into 2 groups. In group 1 (n = 23), 2-3 mg/kg body weight (BW) CyA MEPC was given orally once a day before breakfast. In group 2 (n = 25), 1.5 mg/kg BW CyA MEPC was given twice a day before meals. CyA + prednisolone was continued for 48 weeks. RESULTS: Group 1 showed a significantly higher cumulative complete remission (CR) rate (p = 0.0282), but not when incomplete remission 1 (ICR1; urine protein 0.3-1.0 g/day) was added (p = 0.314). Because a C2 of 600 ng/mL was determined as the best cut-off point, groups 1 and 2 were further divided into subgroups A (C2 ≥600 ng/mL) and B (C2 <600 ng/mL). Groups 1A and 2A revealed significantly higher cumulative remission (CR + ICR1) (p = 0.0069) and CR-alone (p = 0.0028) rates. On the other hand, 3 patients with high CyA levels (C2 >900 ng/mL) in Group 1A were withdrawn from the study because of complications. CONCLUSION: CyA + prednisolone treatment is effective for IMN with associated SRNS at a C2 of ≥600 ng/mL. To achieve remission, preprandial once-a-day administration of CyA at 2-3 mg/kg BW may be the most appropriate option. However, we should adjust the dosage of CyA by therapeutic drug monitoring to avoid complications.


Assuntos
Ciclosporina/administração & dosagem , Glomerulonefrite Membranosa/tratamento farmacológico , Imunossupressores/administração & dosagem , Síndrome Nefrótica/tratamento farmacológico , Adolescente , Adulto , Idoso , Ciclosporina/sangue , Quimioterapia Combinada , Feminino , Glomerulonefrite Membranosa/sangue , Glomerulonefrite Membranosa/complicações , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/sangue , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/sangue , Síndrome Nefrótica/complicações , Prednisolona/uso terapêutico , Estudos Prospectivos , Adulto Jovem
11.
Kidney Blood Press Res ; 37(6): 557-66, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24296802

RESUMO

BACKGROUND/AIMS: Prolonged elevation of serum aldosterone leads to renal fibrosis. Inflammation also plays a role in the pathogenesis of renal disease. We used a rat model of interstitial renal fibrosis to test the hypothesis that eplerenone-mediated aldosterone blockade prevents renal fibrosis due to its anti-inflammatory and anti-proliferative effects. METHODS: Eplerenone (a selective aldosterone blocker) or vehicle (control), was given to male Wistar rats (50 mg/kg, twice daily) for 7 days before unilateral ureteral obstruction (UUO) and for an additional 28 days after surgery. Body weight, blood pressure, renal histo-morphology, immune-staining for macrophages, monocyte chemotactic protein-1, proliferating cell nuclear antigen, α-smooth muscle actin, and serum and urine markers of renal function and oxidative stress were determined for both groups on 7, 14, and 28 days after surgery. RESULTS: Epleronone had no effect on body weight or blood pressure. However, eplerenone inhibited the development of renal fibrosis, inflammation (macrophage and monocyte infiltration), interstitial cell proliferation, and activation of interstitial cells (α-SMA expression). Epleronone also reduced oxidative stress. CONCLUSION: The anti-fibrotic effect of eplerenone appears to be unrelated to its effect on blood pressure. Eplerenone inhibits renal inflammation, interstitial cell proliferation, phenotypic changes of interstitial cells, and reduces oxidative stress.


Assuntos
Proliferação de Células/efeitos dos fármacos , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Nefrite Intersticial/patologia , Nefrite Intersticial/prevenção & controle , Estresse Oxidativo/efeitos dos fármacos , Espironolactona/análogos & derivados , Animais , Modelos Animais de Doenças , Eplerenona , Fibrose , Inflamação/patologia , Inflamação/prevenção & controle , Masculino , Antagonistas de Receptores de Mineralocorticoides/farmacologia , Nefrite Intersticial/metabolismo , Estresse Oxidativo/fisiologia , Distribuição Aleatória , Ratos , Ratos Wistar , Espironolactona/farmacologia , Espironolactona/uso terapêutico
12.
J Infect Chemother ; 19(2): 348-51, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22872187

RESUMO

The aim of this study was to evaluate in vitro the efficacy of clinically using colistin methanesulfonate against biofilm-forming multidrug-resistant Pseudomonas aeruginosa (MDRP), with minimum inhibitory concentrations (MICs) of ciprofloxacin, imipenem, and amikacin showing ≥4, 16, and 32 µg/ml, respectively, by disk diffusion susceptibility testing (CLSI document M100-S21). The minimum eradication biofilm concentration (MBEC) of colistin methanesulfonate for strain MDRP-YMD isolated from a patient's urine, which formed a biofilm on plastic pegs attached to a microplate lid, was compared with that of P. aeruginosa ATCC27853 for quality control testing with MICs of ciprofloxacin, imipenem, and amikacin showing ≤1, 4, and 16 µg/ml, respectively. In an uneven biofilm approximately 10 µm thick, as determined with confocal laser scanning microscopy (CLSM), ratios of MBEC to MIC of colistin methanesulfonate against strains MDRP-YMD and ATCC27853 were 10.5 and 8.0, whereas those of minimum bactericidal concentration (MBC) to MIC in planktonic cells were 1.0 and 2.0 µg/ml, respectively. Morphological examination using scanning electron microscopy and CLSM verified that embedded cells in biofilm matrices of the two strains were disrupted and died under the MBEC. Therefore, bactericidal effects of colistin methanesulfonate on biofilm-forming cells of strain MDRP-YMD as well as strain ATCC27853 were significantly decreased compared with those on the planktonic cells.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Colistina/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/fisiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/microbiologia
13.
Ren Fail ; 35(10): 1445-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23991898

RESUMO

Occasionally, patients with acute Epstein-Barr virus (EBV) infection develop hemophagocytic syndrome (HPS). Acute kidney injury (AKI) is considered a strong prognostic factor, but very few data are available about the biopsy-proven renal involvement of EBV-HPS. Here we describe a previously healthy 17-year-old girl with EBV-HPS. Combination therapy failed and renal necropsy was performed. The renal histology showed that intact glomeruli, remarkable interstitial edema and some cellular infiltration, and protein casts. These findings were compatible with cytokine nephropathy as recently advocated. We suggest that hypercytokinemia may play an important role in the pathophysiology in AKI of EBV-HPS.


Assuntos
Injúria Renal Aguda/etiologia , Citocinas/sangue , Infecções por Vírus Epstein-Barr/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Injúria Renal Aguda/sangue , Injúria Renal Aguda/patologia , Adolescente , Evolução Fatal , Feminino , Humanos , Rim/patologia
14.
Clin Exp Nephrol ; 16(1): 130-5, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21912899

RESUMO

INTRODUCTION: The aim of this study was to investigate the factors influencing serum parathyroid (PTH) levels, including medications for treating chronic kidney disease-mineral and bone metabolism disorder (CKD-MBD) in patients with end-stage renal disease. METHODS: We enrolled 1,076 patients in nine Japanese facilities who had begun hemodialysis (HD) due to ESRD. We investigated the relationships between intact PTH (iPTH) levels and clinical parameters and medications just prior to beginning HD. RESULTS: Significant decreases in serum iPTH levels were seen in males, in the presence of diabetes mellitus (DM), and with administration of renin-angiotensin system inhibitors (RASIs). Significant correlations were found between serum calcium and iPTH levels. In the patients administered RASIs, there was a significant decrease in serum iPTH levels with DM, male gender, and administration of active vitamin D sterols (VDs) compared with those not administered RASIs, although serum-corrected calcium levels were not different. Multiple regression analysis found gender, age, presence of DM, and serum calcium and phosphate levels to be significant contributing factors. In addition, administration of angiotensin II receptor blockers (ARBs) may also be a contributing factor to iPTH levels at the beginning HD (p = 0.050). CONCLUSIONS: In this study, serum iPTH levels were related to administration of ARBs besides gender, age, the presence of DM and serum calcium levels. Our study suggests that the RA system involve serum iPTH levels in uremic patients.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Cálcio/sangue , Falência Renal Crônica/sangue , Hormônio Paratireóideo/sangue , Sistema Renina-Angiotensina/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Sistema Renina-Angiotensina/efeitos dos fármacos , Uremia/sangue , Vitamina D/uso terapêutico
15.
Am J Pathol ; 176(5): 2198-208, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20363914

RESUMO

Endothelial dysfunction is critical in the decline of renal function with. By using endothelial nitric oxide synthase knockout (eNOSKO) mice, we tested the hypothesis that a lack of endothelial nitric oxide synthase accelerates renal injury in the aging kidney. In contrast to control mice and young eNOSKO mice, aging eNOSKO mice showed greater renal injury and in particular developed a thrombotic microangiopathy, with mesangiolysis, endothelial swelling, endothelial cell loss, double-contour appearance of glomerular basement membrane (GBM), and thrombus formation. Thrombi, which were composed of fibrin, platelets, and von Willebrand factor (vWF), were identified predominantly in glomerular capillaries and rarely in arterioles, but not in larger vessels. In the tubulointerstitium, tubular degeneration and macrophage infiltration were also prominent in aging eNOSKO mice. Intraluminal vWF deposition was accompanied with thrombus formation, whereas mesangial deposition of vWF was associated with mesangial matrix expansion. Furthermore, the mesangial vWF deposition was detectable in young eNOSKO mice in which severe glomerular injury had not yet developed. Finally, a higher level of serum P-selectin in eNOSKO mice was consistent with the vWF behavior and suggested exocytosis of the Weibel-Palade body by the endothelium. In conclusion, a lack of endothelial nitric oxide synthase resulted in the development of glomerular thrombotic microangiopathy. A lack of nitric oxide likely contributed to the release of vWF, leading to thrombus formation in this model.


Assuntos
Envelhecimento , Endotélio Vascular/metabolismo , Regulação Enzimológica da Expressão Gênica , Rim/metabolismo , Óxido Nítrico Sintase Tipo III/metabolismo , Microangiopatias Trombóticas/metabolismo , Fator de von Willebrand/metabolismo , Animais , Exocitose , Masculino , Camundongos , Camundongos Knockout , Selectina-P/sangue , Trombose , Corpos de Weibel-Palade/patologia
16.
Clin Exp Nephrol ; 15(6): 942-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21898031

RESUMO

A 42-year-old female end-stage renal disease (ESRD) patient with reversible posterior leukoencephalopathy syndrome (RPLS) post-transfusion during initiation of hemodialysis is reported. Eleven days after the onset of illness, we diagnosed encephalopathy as a grand mal seizure resulting from diffuse cerebral edema. One reason for the delayed diagnosis was that her symptom, a throbbing headache that occurred during her first dialysis, indicated dialysis disequilibrium syndrome. We must bear in mind that a small amount of transfusion could cause RPLS even during the first dialysis. To our knowledge, this is the first case report on RPLS after blood transfusion in an ESRD patient.


Assuntos
Anemia/terapia , Falência Renal Crônica/terapia , Síndrome da Leucoencefalopatia Posterior/etiologia , Diálise Renal/efeitos adversos , Reação Transfusional , Adulto , Anemia/etiologia , Edema Encefálico/etiologia , Angiografia Cerebral/métodos , Diagnóstico Tardio , Imagem de Difusão por Ressonância Magnética , Epilepsia Tônico-Clônica/etiologia , Feminino , Glucocorticoides/uso terapêutico , Glicerol/uso terapêutico , Cefaleia/etiologia , Humanos , Falência Renal Crônica/complicações , Metilprednisolona/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
J Bras Nefrol ; 43(4): 572-579, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33704350

RESUMO

Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD.


Assuntos
Hiperuricemia , Insuficiência Renal Crônica , Taxa de Filtração Glomerular , Humanos , Hiperuricemia/complicações , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Ácido Úrico
19.
Rheumatol Int ; 29(12): 1515-8, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19306000

RESUMO

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease in which a variety of thrombotic events may occur. However, to our knowledge, portal vein thrombosis (PVT), a potential cause of gastrointestinal bleeding, has not been described in the English literature. A previously well 47-year-old man diagnosed with AOSD showed a transient increase in serum transaminase level. A careful observation led to a prompt discovery of a re-increase in serum transaminase level and PVT that involved an entire left portal vein plus parts of supramesenteric vein. PVT resolved completely in 6 months, and the patient remained well for at least 1 year receiving anticoagulants plus an immunosuppressant that selectively inhibits guanosine monophosphate synthesis in the purine metabolism pathway. Thrombotic events, if not lethal, deteriorate the quality of life in AOSD patients. This report illustrates the spectrum of AOSD and underlines the need to include PVT in differential diagnosis if serum liver enzyme levels fluctuate.


Assuntos
Veia Porta , Doença de Still de Início Tardio/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Still de Início Tardio/tratamento farmacológico , Transaminases/sangue , Resultado do Tratamento , Trombose Venosa/tratamento farmacológico
20.
Perit Dial Int ; 29(3): 319-24, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19458305

RESUMO

BACKGROUND: The factors that predict baseline peritoneal permeability remain largely unknown. We noticed that patients that adhered to a strict low protein diet (LPD) during the predialysis period seldom showed high peritoneal permeability on the peritoneal equilibration test (PET) at the introduction of peritoneal dialysis (PD). Therefore, we investigated whether a strict LPD during the predialysis period affects peritoneal permeability. METHOD: We retrospectively analyzed 37 patients that started PD in a single Japanese center. Patients were divided into group A and group B by the median amount of daily protein intake (PI) during the predialysis period using urine collected over 24 hours. RESULTS: There were no differences between groups A and B in age, gender, proportion of diabetic nephropathy, blood pressure, body mass index, or body surface area. There were also no differences between the groups in laboratory findings, including hematocrit, serum albumin, and serum creatinine. The PETs showed a significantly lower dialysate-to-plasma ratio of creatinine at 4 hours (Cr D/P) for group A than for group B (p = 0.02). Furthermore, a significant positive correlation between Cr D/P and PI was observed (r = 0.53, p < 0.01). CONCLUSION: It is suggested that a strict LPD during the predialysis period may suppress peritoneal permeability at induction of PD.


Assuntos
Dieta com Restrição de Proteínas , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Diálise Peritoneal , Peritônio/metabolismo , Adulto , Glicemia/metabolismo , Estudos de Coortes , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Permeabilidade , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA