RESUMEN
Photobiomodulation (PBM) has been used in different populations as a strategy to attenuate muscle fatigue and improve exercise performance. Recent findings demonstrated that a single session with specific PBM doses during hemodialysis (HD) increased the upper limb muscle strength of chronic kidney failure (CKF) patients. Now, the primary objective of this study was to evaluate the chronic effect of PBM on the functional capacity of this population. Secondarily, we aimed at investigating the effects of PBM on the patients' strength, muscle thickness and echogenicity, perception of pain, fatigue, and quality of life. A randomized controlled trial was conducted in which the intervention group (IG, n = 14) received 24 sessions of PBM (810 nm, 5 diodes × 200 mW, 30 J/application site) on lower limb during HD. The control group (CG, n = 14) did not receive any physical therapy intervention, it only underwent HD sessions. As a result, there was an increase in the functional capacity (assessed through the six-minute walk test) for the IG compared with the CG [50.7 m (CI95% 15.63; 85.72), p = 0.01, large effect size, d = 1.12], as well as an improvement on lower limb muscle strength (assessed through the sit-and-stand test) [- 7.4 s (CI95% - 4.54; - 10.37), p = 0.00, large effect size, d = 1.99]. For other outcomes evaluated, no significant difference between-group was observed. Finally, PBM applied as monotherapy for 8 weeks in the lower limb improves functional capacity and muscle strength of CKF patients.
Asunto(s)
Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/radioterapia , Terapia por Luz de Baja Intensidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fatiga Muscular/efectos de la radiación , Fuerza Muscular/efectos de la radiación , Modalidades de Fisioterapia , Calidad de VidaRESUMEN
BACKGROUND: Secondary hyperparathyroidism (SHPT) is a frequently encountered problem in patients with end-stage renal disease (ESRD). Some patients with severe SHPT could not be managed by medical treatment and are ineligible for surgical resection. PURPOSE: Our objective was to evaluate the efficacy, safety of microwave ablation (MWA) on these patients. MATERIALS AND METHODS: Between 1 April 2015 and 28 February 2017, 35 patients (M/F 19/16, age 49.8 ± 12.9 years) were enrolled. All patients were treated with MWA. Levels of intact parathyroid hormone (iPTH) and of serum calcium and phosphorus were compared pre- and post-ablation. Repeated-measures ANOVA was used to compare treatment outcomes pre- and post-ablation. RESULTS: Complete ablation was achieved in all 63 glands in the 35 patients with SHPT. The mean follow-up time was 15.9 ± 2.2 months. The maximum gland diameter was 6-31 mm (mean, 14.9 ± 5.5 mm). The trends of the changes in iPTH and calcium levels showed a curve: the level of iPTH and calcium at 6 months post-ablation were lower than those pre-ablation (both p < .0001); after then iPTH remained relatively stable and the end of follow up, with no rebound (p < .0001), while instead of calcium at the end of follow up was not significantly lower than pre-ablation (p = .462). The trend in the change in phosphate levels showed a straight line; the level of phosphate at 6 months post-ablation and at the end of follow up both were significantly lower than pre-MWA (p < .001). There was no major complication. CONCLUSIONS: In this series, MWA was used successfully to treat SHPT patients who are ineligible for surgical resection.
Asunto(s)
Fallo Renal Crónico/radioterapia , Glándulas Paratiroides/efectos de la radiación , Ablación por Radiofrecuencia/métodos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Chronic patients require ongoing care that results in repeated imaging and exposure to ionizing radiation for both diagnostic and therapeutic purposes. This is of concern due to the long-term effects of radiation exposure, namely the association between radiation and increased cancer risk. In this study, the scientific literature on cumulated dose of radiation accrued from medical imaging by 4 cohorts of chronic patients (cardiac disease, end-stage kidney disease, inflammatory bowel disease, and patients undergoing endovascular aortic repair) was systematically reviewed. We found that the cumulative effective dose is moderate in cardiac and inflammatory bowel disease patients, high in end-stage kidney disease patients, and very high in endovascular aortic repair patients. We concluded that radiation burden of medical imaging is high in selected cohorts of chronic patients. Efforts should be implemented to reduce this cumulative dose and its potential attendant risks.
Asunto(s)
Diagnóstico por Imagen , Dosis de Radiación , Radioterapia , Adulto , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/radioterapia , Carga Corporal (Radioterapia) , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/radioterapia , Enfermedad Crónica , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Enfermedades Inflamatorias del Intestino/radioterapia , Fallo Renal Crónico/diagnóstico por imagen , Fallo Renal Crónico/radioterapia , Protección Radiológica , Radiografía , CintigrafíaAsunto(s)
Humanos , Masculino , Femenino , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/patología , Calidad de Vida/legislación & jurisprudencia , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/terapia , Fallo Renal Crónico/prevención & control , Fallo Renal Crónico/radioterapia , Calidad de Vida/psicología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etiología , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/fisiopatologíaRESUMEN
BACKGROUND: Vascular-access patency is critical for effective and uninterrupted haemodialysis. Limited literature exists evaluating if a surgical or repeated radiological approach is superior for reocclusion following failure of radiological recanalization. Few consistent early predictors of failure have been identified after radiological intervention for thrombosed vascular access. METHODS: 138 patients with thrombosed arteriovenous fistulas or prosthetic grafts treated by radiological intervention, over 10 years, were retrospectively investigated. Reocclusion was treated by either repeated thrombolysis or surgery. Radiological patency rates, after first and second episodes of access thrombosis at 12 months after intervention were analysed. Surgical and radiological patency rates for second access thrombosis were compared. The Cox and logistic regression models were used to identify potential factors associated with reocclusion. RESULTS: In patients who experienced reocclusion within 1 month after radiological intervention, the 3-month repeated radiological patency rate (n = 13) was 38.5%, compared to a 60% surgical patency rate (n = 10), but this did not reach statistical significance. Radiological patency rates after first access thrombosis at 3 and 12 months were 56.6 and 39.5%, respectively. In contrast, radiological patency rates after a second access thrombosis were 51.1 and 24.4%, respectively; a statistical difference in success was not achieved. Native arteriovenous fistulas were 3.23 times as likely to remain patent over 12 months following a first radiological intervention (p < 0.02) and less likely to experience a second reocclusion event (p < 0.01). Anticoagulation was associated with a lower risk of second reocclusion, whilst a history of venous thrombosis was associated with a greater risk (p < 0.02). CONCLUSION: Surgery achieves superior patency rates compared to repeated radiological interventions and should be considered if reocclusion occurs within a month following radiological thrombolysis.
Asunto(s)
Nefrología/métodos , Radiología Intervencionista/métodos , Diálisis Renal/instrumentación , Diálisis Renal/métodos , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Grado de Desobstrucción Vascular , Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Estudios de Cohortes , Humanos , Fallo Renal Crónico/radioterapia , Fallo Renal Crónico/terapia , Modelos Estadísticos , Modelos de Riesgos Proporcionales , Análisis de Regresión , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Previous studies have indicated that the application of low dose radiation to an arterial ligation has the potential to subsequently reduce or eliminate restenosis caused by smooth muscle cell proliferation. Sufficient kidney irradiation causes a radiation nephropathy and often leads to renal failure. In order to evaluate the effect of low-dose irradiation on the kidney we hypothesized that this particular therapy modifies renal injury in rats with renal ablation and subsequently slows the rate of the progression. For further clarification of the effect of irradiation at low doses, we determined proliferating cell nuclear antigen (PCNA) and monocyte chemoattractant protein-1 (MCP-1) expression in remnant kidneys after low-dose radiation. Adult Wistar rats (n = 10) were studied during the two weeks after renal ablation. The left kidney was irradiated 24 hours after an operation in anaesthetised animals with 3 Grey in a single dose. Ablated rats without irradiation (n = 9) served as nephrectomized animals group. Rats without surgery and without radiation (n = 10) served as healthy controls. Renal damage was assessed using the following parameters: urine protein excretion rate (UprotV, mg/day), awake systolic blood pressure (SBP, mm Hg), serum creatinine (SCr, micromol/l). The indirect immunofluorescence method was used for the detection of PCNA and MCP-1 expression. Glomerular and tubular immunostaining was scored semiquantitatively. Numerous PCNA positive cells and MCP-1 expression were present in the glomerulus and tubulointerstitium in nephrectomized rat kidneys. Low-dose radiation application was associated with a significant reduction in PCNA and low MCP-1 expression. This study shows that the application of low-dose irradiation has the potential to modify the progression of chronic renal failure in rats.
Asunto(s)
Fallo Renal Crónico/radioterapia , Riñón/anatomía & histología , Riñón/efectos de la radiación , Animales , Presión Sanguínea/efectos de la radiación , Peso Corporal , Quimiocina CCL2/análisis , Creatinina/sangre , Nefrectomía , Tamaño de los Órganos , Antígeno Nuclear de Célula en Proliferación/análisis , Proteinuria , Ratas , Ratas WistarRESUMEN
In order to evaluate the progression of renal disease, Munich-Wistar rats were submitted to 5/6 nephrectomy and given whole-body x- or gamma-irradiation with or without remnant kidney protection or were submitted only to remnant kidney irradiation. All groups received a single 6-Gy dose immediately after surgery. Whole-kidney function, glomerular hemodynamics, 24-hour proteinuria and histopathology were assessed 60 days after surgery and irradiation. The irradiated nephrectomized animals presented whole-kidney function parameters comparable to those of normal rats. In addition, they were less hypertensive and had higher hematocrit. They showed glomerular hyperfiltration and hypertension even greater than their respective nephrectomized controls. However, the interrelations among the glomerular filtration determinants were somewhat different in irradiated animals. Their 24-hour proteinuria was significantly lower and the sclerosis index and tubulointerstitial injury score were markedly smaller. Among irradiated animals, the worst sclerosis index was observed in those with a shielded remnant kidney and the best in those without protection of the remnant kidney. This led us to speculate about a possible influence of resident mesangial cells on the early events following renal mass ablation and on the maintenance of subsequent physiopathologic changes. Therefore, radiation undoubtedly provoked a beneficial change in the course of renal disease when the renal mass ablation model was employed. Many factors could have contributed to this favorable feature including lower levels of systemic arterial pressure, less increment in DeltaP, diminished proteinuria, and maintenance of tubulointerstitial space integrity. Our data also suggest that development of glomerulosclerosis seems to be determined by events occurring immediately after injury.
Asunto(s)
Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/radioterapia , Glomérulos Renales/fisiopatología , Glomérulos Renales/efectos de la radiación , Circulación Renal/efectos de la radiación , Animales , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Glomérulos Renales/irrigación sanguínea , Masculino , Nefrectomía , Proteinuria/fisiopatología , Proteinuria/radioterapia , Ratas , Ratas Wistar , Irradiación Corporal TotalRESUMEN
The aim of this study was to find out whether an improvement of vitamin D metabolism and its metabolites and a decrease of parathormones can be reached through a diet and UV irradiation. Forty-eight children with kidney insufficiency were divided into four groups: Group 1--diet according to Bergström with EAA and cetoanalogue supplementation plus UV therapy; Group 2--diet plus EAA and cetoanalogue supplementation without UV therapy; Group 3--without diet and supplementation of EAA and ceto but with UV therapy; Group 4--without any diet and without UV therapy. The average levels of kidney insufficiency in all children at the stage of a manifest kidney insufficiency were not significantly different. As a result it became obvious that children exposed to UV irradiation with or without a diet had better post-treatment values and that children with kidney insufficiency reacted to UV therapy plus diet best of all. One can obtain the same results also by oral vitamin D therapy, although we have to point out the danger of calcinosis and stone formation which the author could frequently demonstrate, but never after UV treatment.
Asunto(s)
Aminoácidos Esenciales/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Fallo Renal Crónico/dietoterapia , Fallo Renal Crónico/radioterapia , Terapia Ultravioleta , Vitamina D/sangre , Vitamina D/efectos de la radiación , Niño , Terapia Combinada , Creatinina/sangre , Dihidroxicolecalciferoles/sangre , Humanos , Fallo Renal Crónico/sangre , Hormona Paratiroidea/sangreAsunto(s)
Sangre/efectos de la radiación , Glomerulonefritis/radioterapia , Fallo Renal Crónico/radioterapia , Terapia por Láser , Adulto , Enfermedad Crónica , Estudios de Evaluación como Asunto , Femenino , Glomerulonefritis/complicaciones , Humanos , Fallo Renal Crónico/etiología , Masculino , Síndrome Nefrótico/etiología , Síndrome Nefrótico/radioterapia , Proteinuria/etiología , Proteinuria/radioterapiaRESUMEN
The authors describe a technique of extracorporeal UV radiation of blood (EUVRB) in flow closed circulation. Its efficacy was assessed in combined treatment of pyo-inflammatory complications of terminal renal failure. Therapeutic effects of EUVRB are due to reduced endogenic intoxication, correction of leukopoiesis and stimulation of immunity. The changes in laboratory findings correlated with clinical pattern of the inflammation. EUVRB produced a favourable response and improved therapeutic results of pyo-inflammation treatment in patients with terminal renal failure.