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1.
Biochim Biophys Acta Mol Basis Dis ; 1870(5): 167096, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38499276

RESUMO

Unilateral nephrectomy, a procedure reducing kidney mass, triggers a compensatory response in the remaining kidney, increasing its size and function to maintain a normal glomerular filtration rate (GFR). Recent research has highlighted the role of extracellular vesicles (EVs) in renal physiology and disease, although their involvement in unilateral nephrectomy has been underexplored. In this study, unilateral nephrectomy was performed on young mice, and urinary extracellular vesicles (uEVs) characterization and cargo were analyzed. Kidney volume increased significantly post-nephrectomy, demonstrating compensatory hypertrophy. Serum creatinine, cystatin C, and urinary electrolytes concentrations were similar in both nephrectomized and control groups. Western blot analysis revealed upregulation of sodium-glucose cotransporter 2 (SGLT2) and sodium chloride cotransporter (NCC), and downregulation of sodium­potassium-chloride co-transporter (NKCC2) and epithelial sodium channel (ENaC) in the nephrectomized group. Metabolomic analysis of uEVs showed an enrichment of certain metabolites, including citrate and stachydrine. Interestingly, uEVs from the nephrectomized group demonstrated a protective effect, downregulating signal transducer and activator of transcription 3 (STAT3) and reducing reactive oxygen species (ROS) in renal proximal cells, compared to uEVs from the control group. This study suggests that uEVs contain bioactive components capable of inducing protective, anti-inflammatory, anti-fibrinolytic, and antioxidative effects in renal cells. These findings contribute to our understanding of uEVs' role in renal compensatory mechanisms after unilateral nephrectomy and may hold promise for future therapeutic interventions in renal diseases.


Assuntos
Vesículas Extracelulares , Hipertrofia , Rim , Nefrectomia , Animais , Vesículas Extracelulares/metabolismo , Camundongos , Rim/metabolismo , Rim/patologia , Hipertrofia/metabolismo , Masculino , Metabolômica/métodos , Camundongos Endogâmicos C57BL , Fator de Transcrição STAT3/metabolismo , Espécies Reativas de Oxigênio/metabolismo
2.
Am J Transl Res ; 16(2): 544-556, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38463588

RESUMO

BACKGROUND: Unliteral nephrectomy (UNX) results in the reduction of kidney mass. The remaining kidney undergoes compensatory renal growth via hypertrophy of the glomeruli and renal tubules to maintain a normal glomerular filtration rate (GFR). These compensatory mechanisms result in increased capillary pressure and glomerular hyperfiltration to increase single nephron GFR. Over time, hyperfiltration may lead to kidney scarring and the development of hypertension. OBJECTIVES: The first objective of this study was to test the hypothesis that a 50% reduction in functioning nephrons in juvenile mice leads to increased blood pressure over a 24-hour phase. The second objective was to test the hypothesis that UNX leads to changes in the expression and activity of kidney proteases in juvenile mice. METHODS: Eight male C57B6 juvenile wild-type mice were subject to UNX and an equal number of mice were subject to sham (SH) surgery. Metabolic cage studies were performed for 5 weeks to collect urine produced during the inactive and active phases. Blood pressure was measured using the tail cuff method twice weekly and tail blood was collected on different days during the inactive or active phase of each animal. The mice were euthanized at the age of 9 weeks. Western blotting and immunohistochemistry were performed to investigate changes in renal protein expression of various cathepsins and renal kallikrein 1 (KLK1) between the two groups. Protease activity assays were performed using kidney lysates and urine samples from each group. RESULTS: Compared to the SH group, UNX mice showed a persistent increase in blood pressure at week 3 which progressed toward the end of the study at week 5 of age. Cathepsin B, D, and S expression and activity were up-regulated in kidney cortex lysates from UNX mice compared to the SH control group. KLK1 protein expression was down-regulated and urinary nitric oxide excretion was decreased in UNX mice compared to the SH control group. CONCLUSION: UNX results in the development of persistent and progressive hypertension. Down-regulation of KLK1 and up-regulation of various cathepsins may contribute to the development of hypertension via multiple mechanisms including a decrease in nitric oxide (NO) production.

3.
J Clin Invest ; 134(1)2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-37988172

RESUMO

BACKGROUNDSystemic administration of adeno-associated virus (AAV) can trigger life-threatening inflammatory responses, including thrombotic microangiopathy (TMA), acute kidney injury due to atypical hemolytic uremic syndrome-like complement activation, immune-mediated myocardial inflammation, and hepatic toxicity.METHODSWe describe the kinetics of immune activation following systemic AAV serotype 9 (AAV9) administration in 38 individuals following 2 distinct prophylactic immunomodulation regimens. Group 1 received corticosteroids and Group 2 received rituximab plus sirolimus in addition to steroids to prevent anti-AAV antibody formation.RESULTSGroup 1 participants had a rapid increase in immunoglobulin M (IgM) and IgG. Increase in D-dimer, decline in platelet count, and complement activation are indicative of TMA. All Group 1 participants demonstrated activation of both classical and alternative complement pathways, as indicated by depleted C4 and elevated soluble C5b-9, Ba, and Bb antigens. Group 2 patients did not have a significant change in IgM or IgG and had minimal complement activation.CONCLUSIONSThis study demonstrates that TMA in the setting of AAV gene therapy is antibody dependent (classical pathway) and amplified by the alternative complement pathway. Critical time points and interventions are identified to allow for management of immune-mediated events that impact the safety and efficacy of systemic gene therapy.


Assuntos
Dependovirus , Microangiopatias Trombóticas , Humanos , Dependovirus/genética , Microangiopatias Trombóticas/terapia , Imunoglobulina M , Imunoglobulina G
4.
Pediatr Nephrol ; 38(8): 2669-2678, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36688943

RESUMO

BACKGROUND: Silent lupus nephritis (SLN) is systemic lupus erythematosus (SLE) without clinical and laboratory features of kidney involvement but with biopsy-proven nephritis. This study aims to describe and compare the baseline characteristics and outcomes of pediatric SLN with overt LN (OLN) and to identify associated risk factors and biochemical markers. METHODS: In this retrospective, observational study, multivariate logistic regression and receiver operating characteristic (ROC) analyses studied age, sex, race, serum complements, anti-double-stranded-DNA antibody, anti-Smith antibody, eGFR, and proliferative nephritis. RESULTS: In our cohort of 69 patients, 47 were OLN, and 22 were SLN. OLN (OR = 4.9, p = 0.03) and non-African Americans (AA) (OR = 13.0, p < 0.01) had higher odds, and increasing C3 and C4 were associated with lower odds of proliferative nephritis (OR 0.95 and 0.65 per one unit increase in C3 and C4, respectively, p < 0.01). They demonstrated a good discriminative ability to detect proliferative nephritis as assessed by the area under the ROC curve (C3 = 0.78, C4 = 0.78). C3 and C4 in proliferative SLN and OLN were comparable and significantly lower than their non-proliferative counterparts. No association was observed between age, sex, anti-double-stranded-DNA antibody, anti-Smith antibody, eGFR, and proliferative nephritis. Proliferative SLN and OLN patients received similar treatments. Adverse events were identified in the proliferative OLN only. CONCLUSIONS: Lower complement levels are associated with proliferative lesions in pediatric LN-both SLN and OLN. The non-AA population had higher odds of having proliferative nephritis than the AA. Prospective, randomized, long-term follow-up of proliferative SLN patients is needed to ascertain the beneficial effect of early diagnosis and treatment. A higher resolution version of the Graphical abstract is available as Supplementary information.


Assuntos
Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Humanos , Criança , Estudos Retrospectivos , Estudos Prospectivos , Lúpus Eritematoso Sistêmico/complicações , Proteínas do Sistema Complemento , Biomarcadores , Rim/patologia , Biópsia/efeitos adversos , DNA
5.
PLoS One ; 17(11): e0274598, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36374911

RESUMO

INTRODUCTION: Primary focal segmental glomerulosclerosis (FSGS), a major cause of end-stage kidney disease (ESKD) in adolescents and young adults, is attributable to recognized genetic mutations in a minority of cases. For the majority with idiopathic primary FSGS, the cause of the disease is unknown. We hypothesize that extracellular vesicle (EVs), that carry information between podocytes and mesangial cells, may play a key role in disease progression. MATERIAL & METHODS: A total of 30 participants (20 primary nephrotic syndrome/ 10 healthy controls) were enrolled in this study. Primary nephrotic syndrome subjects were grouped based on pathologic diagnosis. The FSGS group was compared to healthy control subjects based on demographic and clinical findings. EVs were isolated from the urine of each group before being characterized by Western blotting, transmission electron microscopy, and nanoparticle tracking analysis. The effects of the EVs from each group on normal human mesangial cells and activation of certain pathways were then investigated. RESULTS: Based on demographic and clinical findings, mean serum creatinine was significantly higher in the FSGS group than the normal healthy control group. The mean size of the EVs in the FSGS group was significantly higher than the healthy control group. The mesangial cells that were challenged with EVs isolated from FSGS patients showed significant upregulation of STAT-3, PCNA, Ki67, and cell proliferation. DISCUSSION: Our data demonstrate that EVs from FSGS patients stimulate mesangial cell proliferation in association with upregulation of the phospho-STAT-3 pathway. Additional studies are planned to identify the molecular cargo within the EVs from FSGS patients that contribute to the pathogenesis of FSGS.


Assuntos
Vesículas Extracelulares , Glomerulosclerose Segmentar e Focal , Síndrome Nefrótica , Podócitos , Humanos , Criança , Adolescente , Glomerulosclerose Segmentar e Focal/patologia , Síndrome Nefrótica/patologia , Podócitos/metabolismo , Vesículas Extracelulares/metabolismo , Proliferação de Células , Fator de Transcrição STAT3/metabolismo
6.
Pediatr Nephrol ; 37(3): 593-600, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34453602

RESUMO

BACKGROUND: IgA-dominant infection-associated glomerulonephritis is well-documented in adults but has not been studied in depth in children. We assessed the incidence of pediatric IgA-dominant infection-associated glomerulonephritis and clinical and kidney biopsy findings. METHODS: Pediatric native kidney biopsies over a 10-year period with IgA dominance, strong C3, and findings indicative of infection-associated etiology were identified. RESULTS: We identified 9 cases of IgA-dominant infection-associated glomerulonephritis, 0.8% of pediatric native kidney biopsies. Seven patients presented with elevated creatinine. All had hematuria and proteinuria. Eight patients had clinical evidence of infection: one each with central port infection by methicillin-sensitive Staphylococcus aureus, recurrent streptococcal pharyngitis and recent otitis media, streptococcal pharyngitis demonstrated 8 months after biopsy, suspected streptococcal scalded skin syndrome, and viral gastroenteritis, and three with serologic evidence of Streptococcal infection but no identified site of infection. All but one patient experienced short-term normalization of creatinine and resolution of proteinuria, though two eventually progressed to kidney failure: one 3 years later due to progressive disease and one 11 years later due to focal segmental glomerulosclerosis without concurrent immune deposits. CONCLUSIONS: Pediatric IgA-dominant infection-associated glomerulonephritis is rare, and generally has a favorable prognosis, contrasting that seen in adults with severe comorbidities. A higher resolution version of the Graphical abstract is available as Supplementary.


Assuntos
Glomerulonefrite por IGA , Glomerulonefrite , Faringite , Adulto , Criança , Creatinina , Feminino , Glomerulonefrite/complicações , Glomerulonefrite/patologia , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/patologia , Humanos , Imunoglobulina A , Masculino , Proteinúria/etiologia
8.
Kidney Int ; 98(6): 1589-1604, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32750457

RESUMO

There have been few clinical or scientific reports of autosomal dominant tubulointerstitial kidney disease due to REN mutations (ADTKD-REN), limiting characterization. To further study this, we formed an international cohort characterizing 111 individuals from 30 families with both clinical and laboratory findings. Sixty-nine individuals had a REN mutation in the signal peptide region (signal group), 27 in the prosegment (prosegment group), and 15 in the mature renin peptide (mature group). Signal group patients were most severely affected, presenting at a mean age of 19.7 years, with the prosegment group presenting at 22.4 years, and the mature group at 37 years. Anemia was present in childhood in 91% in the signal group, 69% prosegment, and none of the mature group. REN signal peptide mutations reduced hydrophobicity of the signal peptide, which is necessary for recognition and translocation across the endoplasmic reticulum, leading to aberrant delivery of preprorenin into the cytoplasm. REN mutations in the prosegment led to deposition of prorenin and renin in the endoplasmic reticulum-Golgi intermediate compartment and decreased prorenin secretion. Mutations in mature renin led to deposition of the mutant prorenin in the endoplasmic reticulum, similar to patients with ADTKD-UMOD, with a rate of progression to end stage kidney disease (63.6 years) that was significantly slower vs. the signal (53.1 years) and prosegment groups (50.8 years) (significant hazard ratio 0.367). Thus, clinical and laboratory studies revealed subtypes of ADTKD-REN that are pathophysiologically, diagnostically, and clinically distinct.


Assuntos
Anemia , Doenças Renais Policísticas , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Mutação , Doenças Renais Policísticas/genética , Renina/genética , Adulto Jovem
9.
Pediatr Transplant ; 24(6): e13739, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32412694

RESUMO

BK virus encephalitis after HSCT is uncommon. Several reports of native kidney BKVN in patients with HSCT, hematologic malignancies, human immunodeficiency virus infection, and non-renal solid organ transplantation have been described. However, an uncommon combination of BK encephalitis and ESRD of native kidneys secondary to BK virus in a child with HSCT has not been described. We report a 10-year-old boy who presented with a gradually rising serum creatinine during treatment for severe autoimmune hemolytic anemia, which he developed 9 months after receiving an allogeneic HSCT for aplastic anemia. There was no proteinuria or hematuria present. Serum BK virus load was 5 × 106  copies/mL. A renal biopsy showed evidence of BKVN. He developed fever, seizures, and confusion, and the (CSF) showed significant presence of the BK virus (1 × 106  copies/mL) along with biochemical evidence of viral encephalitis. Cerebrospinal fluid cultures were negative. Despite significant clinical symptoms and presence of BK virus in CSF, the magnetic resonance brain imaging findings were minimal. With reduction of immunosuppression, there was resolution of BK encephalitis but BKVN remained resistant to multiple anti-BK virus agents, including leflunomide and cidofovir. He eventually became dialysis-dependent and, 6 years later, received a renal transplant from his mother. This case illustrates that BK virus in severely immunocompromised HSCT recipient may lead to BK encephalitis and BKVN of native kidneys, even without hemorrhagic cystitis, leading to ESRD. Knowledge of such is important for appropriate timely evaluation and management.


Assuntos
Vírus BK , Transplante de Células-Tronco Hematopoéticas/métodos , Falência Renal Crônica/terapia , Infecções por Polyomavirus/terapia , Biópsia , Criança , Cidofovir/administração & dosagem , Creatinina/sangue , Encefalite , Humanos , Falência Renal Crônica/complicações , Leflunomida/administração & dosagem , Masculino , Infecções por Polyomavirus/complicações , Transplantados , Condicionamento Pré-Transplante , Resultado do Tratamento
10.
Am J Kidney Dis ; 76(6): 889-892, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32471796

RESUMO

Children who receive peritoneal dialysis (PD) are at increased risk for thyroid dysfunction. A rarely appreciated cause is iodine overload. We report 4 children who developed iodine overload and secondary hypothyroidism. All had kidney failure treated by PD. Each previously had normal thyroid function screening test results. At the time hypothyroidism was detected, the duration of PD ranged from 1 week to 27 months (median, 6 months). Three children had high thyrotropin values and all had high serum iodine levels. The sole source of iodine exposure in each child was a povidone-iodine-impregnated gauze in the sterile transfer set cap associated with PD. Iodine overload is a poorly appreciated problem associated with the provision of PD in infants and small children and can lead to thyroid dysfunction. Increased awareness among pediatric nephrologists should lead to the development of optimal monitoring and prevention recommendations.


Assuntos
Hipotireoidismo/etiologia , Iodo/efeitos adversos , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Biomarcadores/sangue , Pré-Escolar , Feminino , Humanos , Hipotireoidismo/sangue , Recém-Nascido , Masculino , Tireotropina/sangue
11.
J Inherit Metab Dis ; 40(5): 703-708, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28612263

RESUMO

The onset of microalbuminuria (MA) heralds the onset of glomerulopathy in patients with glycogen storage disease (GSD) type I. Unlike tubulopathy, which responds to improved metabolic control, glomerulopathy in GSD I is considered refractory to medical intervention, and it is thought to inexorably progress to overt proteinuria and renal failure. Recent reports of reduced microalbuminuria following strict adherence to therapy counter this view. In contrast to type Ia, little is known regarding the prevalence of kidney disease in GSD Ib, 0, III, VI, and IX. Subjects were evaluated with 24-h urine collections between 2005 and 2014 as part of a longitudinal study of the natural history of GSD. ACE inhibitor therapy (AIT) was commenced after documentation of microalbuminuria. Elevated urine albumin excretion was detected in 23 of 195 GSD Ia patients (11.7%) and six of 45 GSD Ib (13.3%). The median age of onset of microalbuminuria in GSD Ia was 24 years (range 9-56); in GSD Ib it was 25 years (range 20-38). Of 14 with GSD Ia who complied with dietary and AIT during the study period, microalbuminuria decreased in 11, in whom metabolic control improved. All 135 patients with the ketotic forms of GSD (0, III, VI and IX) consistently had normal microalbumin excretion. Strict adherence to dietary therapy and maintenance of optimal metabolic control is necessary to halt the progression of GSD Ia glomerulopathy in patients treated with AIT. With optimal care, protein excretion can be reduced and even normalize.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doença de Depósito de Glicogênio/complicações , Nefropatias/tratamento farmacológico , Nefropatias/etiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
J. inborn errors metab. screen ; 4: e160030, 2016. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1090917

RESUMO

Abstract Fanconi-Bickel syndrome (FBS), also known as glycogen storage disease type XI (GSD XI), is a rare autosomal recessive disorder of carbohydrate metabolism. It is caused by mutations in the gene SLC2A2, which encodes for the facilitative glucose transporter GLUT2. Diagnosis of FBS is often delayed since the clinical features and laboratory markers often overlap with other disorders whose characteristic features include short stature, fasting hypoglycemia, postprandial hyperglycemia, hepatomegaly, hypophosphatemic rickets, and proximal renal tubular dysfunction. In this article, we present a case of FBS and its management in an African American female who initially presented with persistent proximal tubulopathy, hypercalciuria, and metabolic acidosis. We also include a recent literature review on FBS and discuss other metabolic disorders that should be considered in the differential diagnosis.

13.
Orphanet J Rare Dis ; 7: 70, 2012 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-22998683

RESUMO

BACKGROUND: Arteriosclerosis and emphysema develop in individuals with Schimke immuno-osseous dysplasia (SIOD), a multisystem disorder caused by biallelic mutations in SMARCAL1 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1). However, the mechanism by which the vascular and pulmonary disease arises in SIOD remains unknown. METHODS: We reviewed the records of 65 patients with SMARCAL1 mutations. Molecular and immunohistochemical analyses were conducted on autopsy tissue from 4 SIOD patients. RESULTS: Thirty-two of 63 patients had signs of arteriosclerosis and 3 of 51 had signs of emphysema. The arteriosclerosis was characterized by intimal and medial hyperplasia, smooth muscle cell hyperplasia and fragmented and disorganized elastin fibers, and the pulmonary disease was characterized by panlobular enlargement of air spaces. Consistent with a cell autonomous disorder, SMARCAL1 was expressed in arterial and lung tissue, and both the aorta and lung of SIOD patients had reduced expression of elastin and alterations in the expression of regulators of elastin gene expression. CONCLUSIONS: This first comprehensive study of the vascular and pulmonary complications of SIOD shows that these commonly cause morbidity and mortality and might arise from impaired elastogenesis. Additionally, the effect of SMARCAL1 deficiency on elastin expression provides a model for understanding other features of SIOD.


Assuntos
Arteriosclerose/fisiopatologia , Enfisema/fisiopatologia , Síndromes de Imunodeficiência/fisiopatologia , Síndrome Nefrótica/fisiopatologia , Osteocondrodisplasias/fisiopatologia , Embolia Pulmonar/fisiopatologia , Adulto , Arteriosclerose/genética , Autopsia , Criança , Pré-Escolar , DNA Helicases/genética , Enfisema/genética , Feminino , Humanos , Imuno-Histoquímica , Síndromes de Imunodeficiência/genética , Masculino , Síndrome Nefrótica/genética , Osteocondrodisplasias/genética , Doenças da Imunodeficiência Primária , Embolia Pulmonar/genética
14.
Hum Mutat ; 33(3): 457-66, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22213154

RESUMO

Renal coloboma syndrome, also known as papillorenal syndrome is an autosomal-dominant disorder characterized by ocular and renal malformations. Mutations in the paired-box gene, PAX2, have been identified in approximately half of individuals with classic findings of renal hypoplasia/dysplasia and abnormalities of the optic nerve. Prior to 2011, there was no actively maintained locus-specific database (LSDB) cataloguing the extent of genetic variation in the PAX2 gene and phenotypic variation in individuals with renal coloboma syndrome. Review of published cases and the collective diagnostic experience of three laboratories in the United States, France, and New Zealand identified 55 unique mutations in 173 individuals from 86 families. The three clinical laboratories participating in this collaboration contributed 28 novel variations in 68 individuals in 33 families, which represent a 50% increase in the number of variations, patients, and families published in the medical literature. An LSDB was created using the Leiden Open Variation Database platform: www.lovd.nl/PAX2. The most common findings reported in this series were abnormal renal structure or function (92% of individuals), ophthalmological abnormalities (77% of individuals), and hearing loss (7% of individuals). Additional clinical findings and genetic counseling implications are discussed.


Assuntos
Coloboma/genética , Bases de Dados Genéticas , Fator de Transcrição PAX2/genética , Insuficiência Renal/genética , Refluxo Vesicoureteral/genética , Animais , Humanos
15.
Pediatr Transplant ; 16(5): E162-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21883745

RESUMO

We report a unique case of severe calcification of the aorta, bilateral coronary ostial stenoses and calcification of the mitral valve and left ventricle due to sarcoidosis. The patient underwent neonatal orthotopic heart transplantation secondary to hypoplastic left heart syndrome and developed hypercalcemia with other features of sarcoidosis at 10 yr of age. The mechanism for severe extra-renal calcification localized to the allograft is poorly understood, but may involve discordant local immune modulation and/or calcification-regulation between graft and host tissues.


Assuntos
Doenças da Aorta/diagnóstico , Calcinose/diagnóstico , Cardiomiopatias/diagnóstico , Transplante de Coração , Complicações Pós-Operatórias/diagnóstico , Sarcoidose/diagnóstico , Adolescente , Doenças da Aorta/etiologia , Calcinose/etiologia , Cardiomiopatias/complicações , Humanos , Masculino , Sarcoidose/complicações
16.
Eur J Pediatr ; 169(7): 801-11, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20013129

RESUMO

Schimke immunoosseous dysplasia (SIOD) is an autosomal recessive multisystem disorder characterized by prominent spondyloepiphyseal dysplasia, T cell deficiency, and focal segmental glomerulosclerosis. Biallelic mutations in swi/snf-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1 (SMARCAL1) are the only identified cause of SIOD, but approximately half of patients referred for molecular studies do not have detectable mutations in SMARCAL1. We hypothesized that skeletal features distinguish between those with or without SMARCAL1 mutations. Therefore, we analyzed the skeletal radiographs of 22 patients with and 11 without detectable SMARCAL1 mutations. We found that patients with SMARCAL1 mutations have a spondyloepiphyseal dysplasia (SED) essentially limited to the spine, pelvis, capital femoral epiphyses, and possibly the sella turcica, whereas the hands and other long bones are basically normal. Additionally, we found that several of the adolescent and young adult patients developed osteoporosis and coxarthrosis. Of the 11 patients without detectable SMARCAL1 mutations, seven had a SED indistinguishable from patients with SMARCAL1 mutations. We conclude therefore that SED is a feature of patients with SMARCAL1 mutations and that skeletal features do not distinguish who of those with SED have SMARCAL1 mutations.


Assuntos
Osso e Ossos/diagnóstico por imagem , DNA Helicases/genética , Mutação , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/genética , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Heterogeneidade Genética , Glomerulosclerose Segmentar e Focal/genética , Humanos , Linfopenia/genética , Fenótipo , Radiografia , Síndrome
17.
Pediatr Cardiol ; 30(6): 763-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19449057

RESUMO

Twenty-seven children (ages 8 to 18 years) who had a history of successful coarctation repair (mean transisthmic Doppler gradient [TI-D] <20 mmHg at rest) and had not received antihypertensive medications underwent echocardiogram at rest and immediately following peak exercise with a standard treadmill test. All were normotensive or had isolated systolic hypertension at rest. Right arm-ankle (RA-A) systolic blood pressure (SBP) difference and TI-D were measured. Eleven children (41%) demonstrated exercise-induced hypertension (peak exercise SBP >98th percentile per body surface area) and 17 (63%) had a mean TI-D > or =40 mmHg. Eight underwent MRI or angiography; a residual coarctation (RCoA) was confirmed in three and excluded in five. RCoA was excluded in three other children who were normotensive at rest and had normal postoperative echocardiographic findings. No individual test (SBP, RA-A SBP, TI-D) at rest or with exercise testing was statistically useful to identify RCoA. However, the requirement for a RA-A SBP difference > or =20 mmHg and a TI-D > or =40 mmHg during exercise testing was a useful screen: RCoA was present in three of five children who fit these criteria but was absent in six of six who did not.


Assuntos
Coartação Aórtica/diagnóstico , Ecocardiografia Doppler , Teste de Esforço/métodos , Adolescente , Angiografia , Coartação Aórtica/fisiopatologia , Coartação Aórtica/cirurgia , Pressão Sanguínea/fisiologia , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Prognóstico
18.
J Heart Lung Transplant ; 27(2): 242-4, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18267235

RESUMO

Despite increasing clinical experience in adult transplantation, induction therapy with alemtuzumab (Campath-1H) has rarely been reported in pediatric solid-organ transplants, and has been limited to kidneys, intestine and multi-visceral organs. Basic science research and clinical observations reported from the adult experience suggest potential benefits of alemtuzumab in pediatric organ recipients. We report successful induction therapy with alemtuzumab and steroid-free maintenance therapy for cardiac transplantation in a teenager, and discuss its merits in this patient.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Anticorpos Antineoplásicos/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Insuficiência Cardíaca/cirurgia , Transplante de Coração/imunologia , Adolescente , Alemtuzumab , Anticorpos Monoclonais Humanizados , Cardiomiopatia Dilatada/complicações , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/métodos , Humanos , Imunossupressores/uso terapêutico , Cuidados Pós-Operatórios/métodos , Medição de Risco , Imunologia de Transplantes/efeitos dos fármacos , Transplante Homólogo , Resultado do Tratamento
19.
Pediatr Cardiol ; 29(5): 1000-1, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18060446

RESUMO

We describe a case of mid-aortic syndrome presenting as systemic hypertension in infancy and early childhood. Angiography of the descending and abdominal aorta is the diagnostic test of choice to confirm the diagnosis of mid-aortic syndrome. Severity of hypertension is one of the major factors in determining the timing of intervention. Because of variability in the anatomic extent of mid-aortic syndrome, management options need to be individualized.


Assuntos
Aorta Abdominal/patologia , Coartação Aórtica/diagnóstico , Coartação Aórtica/cirurgia , Hipertensão Renovascular/etiologia , Angioplastia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Constrição Patológica , Humanos , Artéria Ilíaca/anormalidades , Artéria Ilíaca/patologia , Artéria Ilíaca/cirurgia , Recém-Nascido , Radiografia , Artéria Renal/patologia , Síndrome
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