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1.
Medicine (Baltimore) ; 102(50): e36560, 2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-38115241

RESUMO

RATIONALE: Immune system deregulation, including AAV, is a key event that may potentially evolve into ESRD. Abnormal activation of the cAP is also a cardinal feature of TMA, particularly aHUS. The kidney is the most frequently involved organ, and renal-limited forms of TMA are often encountered in clinical practice. Isolated case reports described the occurrence of renal TMA in AAV patients. Some cases of both de novo and relapses of AAV and/or TMAs after anti-SARS-CoV2 vaccination have been reported. We reported, for the 1st time, a case of patients with new-onset MPA and aHUS occurring 3 weeks after the third dose of mRNA-1273 vaccine anti-SARS-CoV2. PATIENT CONCERNS: We present a 67-year-old man, affected by arterial hypertension, reported, after mRNA-1273 vaccine anti-SARS-CoV2, anuria, fatigue, anorexia and nausea. Laboratory data revealed acute renal failure. DIAGNOSIS: Positivity of MPO-ANCA was observed. 7 days after admission, we observed a worsening of anemia and thrombocytopenia with haptoglobin reduction, LDH increase and presence of schistocytes. Plasma levels of ADAMTS-13 were normal. A renal biopsy was performed, and findings were consistent with microscopic polyangiitis, with features of micro-thrombotic glomerulopathy. Genetic tests revealed absence of hybrid genes associated with the increased risk of aHUS. INTERVENTIONS AND OUTCOMES: We started renal replacement treatment, including hemodialysis, and pulsed methylprednisolone, with no improvement of laboratory parameters. Then, plasma exchange was performed leading to partial haematological response. Only with Eculizumab, a human C5 inhibitor, we observed a normalization of haptoglobin levels and platelets' count. However, three months after discharge, the patient still required hemodialysis. LESSONS: To our knowledge we observed the first case aHUS, without genetic predisposition, associated with MPA occurring after the third dose of anti-SARS-CoV2 vaccine. This case report highlights the potential link between anti-SARS-CoV2 vaccine as a trigger of MPA and aHUS. This systematic review offers additional perspectives. It is plausible to hypothesize that the vaccine was the trigger for the development of these 2 diseases.Solid evidence on the mechanisms of interaction between vaccine and immune system, the role of genetic predisposition, and other variables, will shed additional light on the controversial link between anti-SARS-CoV2 vaccine and autoimmunity.


Assuntos
Síndrome Hemolítico-Urêmica Atípica , COVID-19 , Falência Renal Crônica , Poliangiite Microscópica , Masculino , Humanos , Idoso , Síndrome Hemolítico-Urêmica Atípica/genética , Vacina de mRNA-1273 contra 2019-nCoV , Poliangiite Microscópica/complicações , Haptoglobinas/genética , COVID-19/complicações , Falência Renal Crônica/terapia , Falência Renal Crônica/etiologia , Predisposição Genética para Doença
2.
Int J Mol Sci ; 24(6)2023 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-36982359

RESUMO

Kidney transplantation (KT) is the optimal therapeutic strategy for patients with end-stage renal disease. The key to post-transplantation management is careful surveillance of allograft function. Kidney injury may occur from several different causes that require different patient management approaches. However, routine clinical monitoring has several limitations and detects alterations only at a later stage of graft damage. Accurate new noninvasive biomarker molecules are clearly needed for continuous monitoring after KT in the hope that early diagnosis of allograft dysfunction will lead to an improvement in the clinical outcome. The advent of "omics sciences", and in particular of proteomic technologies, has revolutionized medical research. Proteomic technologies allow us to achieve the identification, quantification, and functional characterization of proteins/peptides in biological samples such as urine or blood through supervised or targeted analysis. Many studies have investigated proteomic techniques as potential molecular markers discriminating among or predicting allograft outcomes. Proteomic studies in KT have explored the whole transplant process: donor, organ procurement, preservation, and posttransplant surgery. The current article reviews the most recent findings on proteomic studies in the setting of renal transplantation in order to better understand the effective potential of this new diagnostic approach.


Assuntos
Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Proteômica/métodos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/urina , Rim , Biomarcadores/urina
3.
J Clin Med ; 12(5)2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36902718

RESUMO

Chyloperitoneum (chylous ascites) is a rare complication of peritoneal dialysis (PD). Its causes may be traumatic and nontraumatic, associated with neoplastic disease, autoimmune disease, retroperitoneal fibrosis, or rarely calcium antagonist use. We describe six cases of chyloperitoneum occurring in patients on PD as a sequel to calcium channel blocker use. The dialysis modality was automated PD (two patients) and continuous ambulatory PD (the rest of the patients). The duration of PD ranged from a few days to 8 years. All patients had a cloudy peritoneal dialysate, characterized by a negative leukocyte count and sterile culture tests for common germs and fungi. Except for in one case, the cloudy peritoneal dialysate appeared shortly after the initiation of calcium channel blockers (manidipine, n = 2; lercanidipine, n = 4), and cleared up within 24-72 h after withdrawal of the drug. In one case in which treatment with manidipine was resumed, peritoneal dialysate clouding reappeared. Though turbidity of PD effluent is due in most cases to infectious peritonitis, there are other differential causes including chyloperitoneum. Although uncommon, chyloperitoneum in these patients may be secondary to the use of calcium channel blockers. Being aware of this association can lead to prompt resolution by suspension of the potentially offending drug, avoiding stressful situations for the patient such as hospitalization and invasive diagnostic procedures.

4.
Ther Apher Dial ; 27(2): 278-283, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35838337

RESUMO

INTRODUCTION: Acute liver failure (ALF) is a rare syndrome defined by the rapid loss of liver function in the absence of pre-existing liver disease, which may be secondary to hepatitis A virus, hepatitis E virus (HEV), or to drugs in about 50% of cases. Extracorporeal albumin dialysis enables the elimination of albumin-bound toxins that accumulate in liver failure. METHODS: We report a case of ALF secondary to HEV associated with severe hyperbilirubinemia. Patient was treated with four consecutive sessions of single-pass albumin dialysis (SPAD) carried out setting the following parameters: time: 300 min, Qb: 60 mL/min, Qd: 800-1000 mL/min, dialysate containing 4% albumin, citrate: 3-4 mmol/L. RESULT: SPAD documented good support of liver function. Bilirubin levels were reduced from 22 to 14 g/dL after four treatments. Pruritus was the first clinical sign of improvement. CONCLUSION: SPAD system can represent a safe and effective therapeutic option.


Assuntos
Hepatite E , Falência Hepática Aguda , Falência Hepática , Humanos , Diálise Renal , Albuminas , Falência Hepática/terapia , Falência Hepática Aguda/terapia , Hiperbilirrubinemia
5.
Int J Artif Organs ; 46(2): 81-84, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36482663

RESUMO

Acute and acute-on-chronic liver failure is a cause of death in patients suffering from viral hepatitis, and many cases need liver transplantation. Infection from hepatitis B virus may range from asymptomatic to severe acute and fulminant hepatitis. In this setting, treatment is mainly supportive as there is no consensus on antiviral therapy based on non-nucleoside reverse transcriptase inhibitors. Single-pass albumin dialysis is a liver-support technique for patients suffering from liver failure, that has shown effectiveness in the removal of both water-soluble and albumin-bound toxins, which accumulate due to impairment of the liver's cleansing function. We report here the case of a 62-year-old male who presented with a severe acute hepatitis B infection, liver failure, and marked hyperbilirubinemia. Treatment with single-pass albumin dialysis combined with a hemoperfusion device was successful in improving clinical, physiological, and laboratory parameters.


Assuntos
Hemoperfusão , Hepatite B , Falência Hepática , Masculino , Humanos , Pessoa de Meia-Idade , Diálise Renal/métodos , Hemoperfusão/métodos , Albuminas , Falência Hepática/terapia
6.
Biomedicines ; 10(4)2022 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-35453594

RESUMO

Hemodialysis is a life-sustaining therapy for millions of people worldwide. However, despite considerable technical and scientific improvements, results are still not fully satisfactory in terms of morbidity and mortality. The membrane contained in the hemodialyzer is undoubtedly the main determinant of the success and quality of hemodialysis therapy. Membrane properties influence solute removal and the interactions with blood components that define the membrane's biocompatibility. Bioincompatibility is considered a potential contributor to several uremic complications. Thus, the development of more biocompatible polymers used as hemodialyzer membrane is of utmost importance for improving results and clinical patient outcomes. Many different surface-modified membranes for hemodialysis have been manufactured over recent years by varying approaches in the attempt to minimize blood incompatibility. Their main characteristics and clinical results in hemodialysis patients were reviewed in the present article.

7.
High Blood Press Cardiovasc Prev ; 29(2): 163-167, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34978702

RESUMO

INTRODUCTION: Coronavirus 2 disease is associated with increased mortality and morbidity in chronic hemodialysis patients METHODS: A retrospective, observational case-control pilot study was conducted on consecutive hemodialysis outpatients (cases) and control group of individuals with preserved renal function. Complete SARS-CoV-2 vaccination with BNT162b2 mRNA vaccine, followed by determination of serum antibodies after the second dose, were required from participants in both groups. Previous COVID-19 was an exclusion criterium. RESULTS: 21 hemodialysis patients (M:F = 13:8, mean age 67.5 ± 13.4) and 16 controls without chronic kidney disease (M:F = 4:12, mean age 46.8 ± 12.7) were included. Hemodialysis patients had lower mean titers of serum antibodies to the SARS-CoV-2 spike antigen compared with controls (492.39 vs 1901.20 IU/mL, respectively; p < 0.001), a finding that was confirmed in the age-matched analysis on 18 participants (580.8 vs 1836.4 IU/mL, p = 0.006). CONCLUSIONS: This study supports the finding of hyporesponsiveness to mRNA vaccination among hemodialysis patients.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais , Vacina BNT162 , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Estudos de Casos e Controles , Humanos , Imunidade Humoral , Pessoa de Meia-Idade , Projetos Piloto , Diálise Renal/efeitos adversos , Estudos Retrospectivos , SARS-CoV-2 , Vacinação , Vacinas Sintéticas , Vacinas de mRNA
8.
J Pers Med ; 11(12)2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34945839

RESUMO

BACKGROUND: Chronic renal failure is a chronic medical condition characterized by a progressive and irreversible loss of kidney function. Up to 50% of patients undergoing dialysis experience symptoms of depression and anxiety: what is the impact of individual factors and medical conditions on the mental health issue? The present study was carried out to investigate the individual factors (biomarkers and psychological dimensions) of end-stage renal disease patients dealing with dialysis, analyzing their predictor values for developing negative disease adaptations by an allostatic paradigm. METHODS: We conducted an observational study on 35 patients affected by end-stage renal disease; biological and psychological markers have been detected. We conducted descriptive statistical analyses (t-tests) and performed a hierarchical regression analysis to investigate the relationship between pathological medical conditions and psychological dimensions. RESULTS: The findings showed a positive correlation between creatinine levels and psychological distress as well as stress index. No significant effect of "time of dialysis", "time from diagnosis", "age" and "personality traits" was found. CONCLUSION: Our findings showed that personality traits did not represent a protective factor by moderating positive emotional adaptations; conversely, creatinine levels appeared predictive for negative emotional adaptations. High levels of creatinine were found to be positively associated with high stress levels as well psychological distress. According to the allostatic paradigm, end-stage renal disease patients could experience an allostatic load and more overload towards poor health outcomes; integrated biological and psychological measurements could prevent increased negative mental health through a patient-centered approach.

9.
Int J Mol Sci ; 22(6)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33802652

RESUMO

Red blood cells (RBCs) have been found to synthesize and release both nitric oxide (NO) and cyclic guanosine monophosphate (cGMP), contributing to systemic NO bioavailability. These RBC functions resulted impaired in chronic kidney disease (CKD). This study aimed to evaluate whether predialysis (conservative therapy, CT) and dialysis (peritoneal dialysis, PD; hemodialysis, HD) therapies used during CKD progression may differently affect NO-synthetic pathway in RBCs. Our data demonstrated that compared to PD, although endothelial-NO-synthase activation was similarly increased, HD and CT were associated to cGMP RBCs accumulation, caused by reduced activity of cGMP membrane transporter (MRP4). In parallel, plasma cGMP levels were increased by both CT and HD and they significantly decreased after hemodialysis, suggesting that this might be caused by reduced cGMP renal clearance. As conceivable, compared to healthy subjects, plasma nitrite levels were significantly reduced by HD and CT but not in patients on PD. Additionally, the increased carotid intima-media thickness (IMT) values did not reach the significance exclusively in patients on PD. Therefore, our results show that PD might better preserve the synthetic NO-pathway in CKD-erythrocytes. Whether this translates into a reduced development of uremic vascular complications requires further investigation.


Assuntos
Eritrócitos/metabolismo , Óxido Nítrico/biossíntese , Óxido Nítrico/sangue , Diálise Peritoneal , Diálise Renal , Uremia/sangue , Idoso , GMP Cíclico/sangue , GMP Cíclico/metabolismo , Feminino , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Óxido Nítrico Sintase/metabolismo , Nitritos/sangue , Nitrosação , Fosforilação
11.
Int J Mol Sci ; 21(14)2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664269

RESUMO

Cancer patients have an incidence of about 60% kidney disease development and are at elevated risk of acute renal damage. Kidney disease in these patients is frequently associated with nephrotoxicity from the ongoing oncological treatment. New anticancer therapeutic strategies, such as targeted therapies and immunotherapies, offer substantial benefits in the treatment of many neoplasms. However, their use is associated with significant nephrotoxicity, which qualitatively differs from that seen with traditional cytotoxic chemotherapy, while the underlying mechanisms are complex and still to be clearly defined. Nephrologists need to be knowledgeable about the array of such renal toxicities for effective collaboration with the oncologist in the prevention and management of kidney involvement. Renal adverse effects may range from asymptomatic proteinuria to renal failure, and their prompt identification and timely treatment is essential for optimal and safe care of the patient. In this article, after presenting clinical cases we discuss the differing renal toxicity of three novel anticancer agents (aflibercept, dasatinib, and nivolumab) and possible measures to counter it.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Antineoplásicos/efeitos adversos , Dasatinibe/efeitos adversos , Rim/efeitos dos fármacos , Nivolumabe/efeitos adversos , Proteínas Recombinantes de Fusão/efeitos adversos , Antineoplásicos/uso terapêutico , Dasatinibe/uso terapêutico , Humanos , Neoplasias/tratamento farmacológico , Nivolumabe/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico
12.
G Ital Nefrol ; 36(3)2019 Jun 11.
Artigo em Italiano | MEDLINE | ID: mdl-31251002

RESUMO

Calcific uremic arteriolopathy, also known as calciphylaxis (CUA), is a rare and potentially fatal condition that occurs in 1-4% of the population with chronic renal failure, most often on dialysis treatment. The pathogenesis is not yet clear although several hypotheses have been advanced, most importantly the alteration of the calcium phosphorus metabolism. Administration of sodium thiosulfate (STS) is the emerging therapy. Below, we report the case of an elderly chronic kidney patient on conservative therapy suffering from CUA who has been successfully treated with STS.


Assuntos
Calciofilaxia/tratamento farmacológico , Tiossulfatos/uso terapêutico , Idoso de 80 Anos ou mais , Calciofilaxia/complicações , Tratamento Conservador , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Resultado do Tratamento
13.
G Ital Nefrol ; 35(2)2018 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-29582966

RESUMO

Hepatitis E virus (HEV) is a significant public health problem that affects almost 20 million individuals annually and cause acute liver injury in 3,5 million. Hepatitis E virus can cause acute, fulminant and chronic hepatitis and has been associated with a range of extrahepatic manifestation. The spectrum of these manifestation is still emerging. Acute pancreatitis and neurological, renal, hematologic, and muscoloskeletal manifestations have been described. Renal injury include membranoproliferative glomerulonephritis with or without cryoglobulinemia, membranous glomerulonephritis and tubular necrosis. The etiopathogenesis of extrahepatic manifestation is only supposed. It could be caused by a direct tossic effect of HEV or by an autoimmune process. We report a case of a 46 years old man who presented with acute hepatitis E. He was diagnosed to have acute severe renal failure and severe pancreatitis due to hepatitis E. Few cases have been reported in the literature concerning patients suffering from hepatitis E and severe extraepatic manifestations with a benign course and complete recovery.


Assuntos
Injúria Renal Aguda/etiologia , Hepatite E/complicações , Pancreatite Necrosante Aguda/etiologia , Injúria Renal Aguda/terapia , Comorbidade , Tratamento Conservador , Hepatite E/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Complicações Pós-Operatórias , Diálise Renal
14.
G Ital Nefrol ; 34(Nov-Dec)2017 Dec 05.
Artigo em Italiano | MEDLINE | ID: mdl-29207221

RESUMO

Glucocorticoid-induced osteoporosis (GIO) is a major cause of secondary osteoporosis that starts early after the beginning of therapy even for low drug doses. Glucocorticoids are used for the treatment of immunologic nephropathies and in the setting of kidney transplant. In clinical practice, a number of algorithms are available; they allow us to estimate the long-term risk of major osteoporotic fracture; but none of them is specific for GIO. To date, the therapeutic approach comprises both general measures aimed at correcting calcium and vitamin D intake, and drugs (bisphosphonates, teriparatide, hormone replacement therapy, denosumab) that ameliorate bone mineral density and patient outcomes.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Glucocorticoides/efeitos adversos , Osteoporose/tratamento farmacológico , Cálcio/uso terapêutico , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Quimioterapia Combinada , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Osteoporose/induzido quimicamente , Osteoporose/diagnóstico , Osteoporose/prevenção & controle , Guias de Prática Clínica como Assunto , Teriparatida/uso terapêutico , Vitamina D/uso terapêutico
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