RESUMO
AIM: To document the feasibility and report the results of dosing darbepoetin-alpha at extended intervals up to once monthly (QM) in a large dialysis patient population. MATERIAL: 175 adult patients treated, at 23 Swiss hemodialysis centres, with stable doses of any erythropoiesis-stimulating agent who were switched by their physicians to darbepoetin-alpha treatment at prolonged dosing intervals (every 2 weeks [Q2W] or QM). METHOD: Multicentre, prospective, observational study. Patients' hemoglobin (Hb) levels and other data were recorded 1 month before conversion (baseline) to an extended darbepoetin-alpha dosing interval, at the time of conversion, and once monthly thereafter up to the evaluation point (maximum of 12 months or until loss to follow-up). RESULTS: Data for 161 evaluable patients from 23 sites were included in the final analysis. At 1 month prior to conversion, 73% of these patients were receiving darbepoetin-alpha weekly (QW) and 27% of the patients biweekly (Q2W). After a mean follow-up of 9.5 months, 34% received a monthly (QM) dosing regimen, 52% of the patients were receiving darbepoetin-alpha Q2W, and 14% QW. The mean (SD) Hb concentration at baseline was 12.3 +/- 1.2 g/dl, compared to 11.9 +/- 1.2 g/dl at the evaluation point. The corresponding mean weekly darbepoetin-alpha dose was 44.3 +/- 33.4 microg at baseline and 37.7 +/- 30.8 microg at the evaluation point. CONCLUSIONS: Conversion to extended darbepoetin-alpha dosing intervals of up to QM, with maintenance of initial Hb concentrations, was successful for the majority of stable dialysis patients.
Assuntos
Anemia/prevenção & controle , Eritropoetina/análogos & derivados , Hematínicos/administração & dosagem , Diálise Renal/estatística & dados numéricos , Idoso , Algoritmos , Anemia/sangue , Anemia/etiologia , Darbepoetina alfa , Relação Dose-Resposta a Droga , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Eritropoetina/administração & dosagem , Estudos de Viabilidade , Feminino , Hemoglobinas/análise , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Crystal aggregation (AGN) destabilizes crystal suspensions and during crystalluria probably favors crystal apposition to kidney calcifications and preexisting stones. We analyzed inhibition of AGN and stabilization of calcium oxalate suspensions by urinary macromolecules (UM), urine and solutions with urinary citrate concentration. MATERIALS AND METHODS: Solutions of UM (UMS) were obtained by a hemofiltration procedure from urine of 6 healthy men. Calcium oxalate suspensions were prepared in all solutions and urine by adjusting Ca2+ to 1.5 mM and by an oxalate titration to 1.0 mM. Crystallization was monitored measuring optical density (OD). Stability of suspensions (SS) was defined as the time without sedimentation and zeta potential (ZP) of crystals was measured. AGN was visualized by scanning electron microscopy and quantified by maximal OD. RESULTS: UMS inhibited AGN and increased ZP and SS. Most inhibitory activity of urine could be attributed to UM. 3.3-fold dilution of UM reduced SS only by 30%. CONCLUSIONS: During crystalluria, UM of healthy men are supposed to protect from stone formation by inhibiting AGN and stabilizing crystal suspensions. As a probably important aspect, this protection was found to be limited in time and may favorably be influenced by an increase of diuresis.
Assuntos
Oxalato de Cálcio/urina , Substâncias Macromoleculares/urina , Urolitíase/prevenção & controle , Oxalato de Cálcio/química , Citratos/química , Cristalização , Hemofiltração , Humanos , Masculino , Microscopia Eletrônica de Varredura , Propriedades de Superfície , Fatores de Tempo , Urolitíase/urinaRESUMO
A 27 year old patient presented with a sudden acute illness showing right flank pain, milky urine, nephrotic range proteinuria, erythrocyturia and leukocyturia in the urinary sediment with a negative leukocyte test stick. The proof of a pronounced hypertriglyceriduria led to the diagnosis of Chyluria. The lymphangiogram confirmed the presence of a retroperitoneal lymphatic dysplasia with evidence of communication with the right renal pelvis on the CT-lymphogram. Chyluria is generally the result of parasitic infection and is extremely rare in Europe. In the presence of symptoms including milky urine, proteinuria and leukocyturia in the urinary sediment and a negative urine leukocyte stick test and absence of infectious signs, chyluria must be suspected. The diagnosis should be substantiated through proof of hypertriglyceriduria and confirmed by lymphangiography.
Assuntos
Quilo , Doenças Linfáticas/complicações , Síndrome Nefrótica/etiologia , Doença Aguda , Adulto , Feminino , Humanos , Hipercolesterolemia/complicações , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/cirurgia , Linfografia , Síndrome Nefrótica/urina , Dor/etiologia , Proteinúria/etiologia , Tomografia Computadorizada por Raios X , Triglicerídeos/urina , UrinaRESUMO
An eighty-year-old woman suffered from acute idiopathic gout of the right sacroiliac joint and tophaceous deposits in two fingers of her right hand. Hyperuricemia and findings consistent with gout detected by histological examination of a biopsy specimen taken from the digital nodules supported the diagnosis. The radiological workup revealed osteolytic changes at the bases of the phalanges in Roentgenograms of the feet. Various aspects of the very rare incidence of sacroiliac gout are discussed.
Assuntos
Artrite Gotosa/diagnóstico , Articulação Sacroilíaca , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Alopurinol/uso terapêutico , Artrite Gotosa/tratamento farmacológico , Artrite Gotosa/patologia , Biópsia por Agulha , Colchicina/uso terapêutico , Feminino , Articulações dos Dedos , Supressores da Gota/uso terapêutico , HumanosRESUMO
Sebaceous adenomas and squamous cell carcinoma developed in a male patient in addition to viral, mycotic and bacterial infections, several years after the removal of three malignant tumors from his lower gastrointestinal and urinary tract. Skin tests with trichophytin, candidin, and mixed bacteria were negative. Various aspects regarding cutaneous changes associated with colorectal and bladder carcinomas are discussed.
Assuntos
Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Sebáceo/etiologia , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células de Transição/complicações , Neoplasias Colorretais/complicações , Dermatopatias Infecciosas/etiologia , Neoplasias Cutâneas/etiologia , Neoplasias da Bexiga Urinária/complicações , Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Sebáceo/patologia , Adenocarcinoma Sebáceo/fisiopatologia , Idoso , Candidíase Cutânea/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/fisiopatologia , Carcinoma de Células de Transição/cirurgia , Neoplasias Colorretais/cirurgia , Herpes Zoster/etiologia , Humanos , Masculino , Dermatopatias Bacterianas/etiologia , Dermatopatias Infecciosas/patologia , Dermatopatias Infecciosas/fisiopatologia , Dermatopatias Virais/etiologia , Neoplasias Cutâneas/fisiopatologia , Testes Cutâneos , Tinha/etiologia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Paget's bone disease developed in a patient with vitiligo. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed a reversed CD4/CD8 ratio due to a very low CD4 cell percentage and almost negligible responses to PHA as well as Con A, T cell mitogens. The pathogenic significance of these results, which point to phenotypic and functional T cell defects, is discussed.
Assuntos
Osteíte Deformante/complicações , Vitiligo/complicações , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Osteíte Deformante/diagnóstico por imagem , Radiografia , Vitiligo/patologiaRESUMO
Dermatomyositis and carcinoma of colon were diagnosed in a 66-year-old woman. Meticulous physical examination excluded further systemic or cutaneous involvement. The musculocutaneous disorders responded well to daily oral corticosteroid, and the malignant tumor was totally removed surgically. After a seven-year follow-up of actual dermatomyositis controlled by maintenance doses of prednisone ranging from 5 to 15 mg daily, the patient developed a meningioma. Current concepts and data regarding various aspects of the combination between dermatomyositis and tumors are discussed. To our knowledge, this is the first reported case of meningioma associated with dermatomyositis.
Assuntos
Adenocarcinoma/complicações , Neoplasias do Colo/complicações , Dermatomiosite/complicações , Neoplasias Meníngeas/complicações , Meningioma/complicações , Segunda Neoplasia Primária , Idoso , Feminino , HumanosRESUMO
A patient with a 46-year history of vitiligo who also presented rheumatoid arthritis and pernicious anemia is described. Meticulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed a low CD4 cell percentage with T cells mostly composed of CD8 cells, a discrepancy between the high percentage of cumulative CD4 + CD8 cells and the measured CD3 proportions, very low NK cytotoxicity toward K562 cells, and almost negligible responses to PHA, Con A and PWM mitogens. The results point to severe T and NK cell functional defects. The pathogenetic significance of these data is discussed.
Assuntos
Anemia Perniciosa/complicações , Anemia Perniciosa/imunologia , Artrite Reumatoide/complicações , Artrite Reumatoide/imunologia , Vitiligo/complicações , Vitiligo/imunologia , Idoso , Linfócitos B/imunologia , Linfócitos B/patologia , Feminino , Humanos , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/patologia , Ativação Linfocitária/imunologia , Linfócitos T/imunologia , Linfócitos T/patologiaRESUMO
Dermatomyositis developed suddenly in a diabetic patient with CREST syndrome after the removal of a malignant tumor. Scrupulous physical examination excluded further systemic or cutaneous involvement. We raise certain still unsolved aspects regarding the association between dermatomyositis and neoplastic disorders.
Assuntos
Neoplasias da Mama/cirurgia , Dermatomiosite/complicações , Neoplasias da Mama/complicações , Calcinose/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Doença de Raynaud/complicações , SíndromeRESUMO
A patient with chronic metal intoxication is described, presenting during four years after the cessation of her exposure to industrial substances, maculo-papular eruptions with several ulcerated lesions and excoriations on her abdomen and buttocks. She also had pallor of her face, greyish-dark discoloration of the hair, while the fingernails were brittle and sensitive. Scrupulous physical examination excluded further cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.
Assuntos
Dermatite de Contato/etiologia , Dermatite Ocupacional/etiologia , Metalurgia , Pintura , Dermatite de Contato/imunologia , Dermatite Ocupacional/imunologia , Feminino , Humanos , Imunidade Celular , Pessoa de Meia-Idade , Pele/imunologia , Fatores de TempoAssuntos
Eritema Migrans Crônico , Doença de Lyme , Adulto , Eritema Migrans Crônico/patologia , Humanos , Israel , MasculinoRESUMO
Ten Gore-tex and ten Oreopoulos peritoneal catheters were evaluated in a comparative clinical trial with an average follow-up of 13 1/2 months per catheter. Catheter survival was significantly poorer in the Gore-tex group (p = 0.0016) because of catheter-related complications like tunnel infections, fissure, migration and painful catheter which made it necessary to remove seven Gore-tex catheters. Substantial corrections of the Gore-tex catheter design are proposed.
Assuntos
Cateteres de Demora , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Cateteres de Demora/efeitos adversos , Desenho de Equipamento , Estudos de Avaliação como Assunto , HumanosRESUMO
Twelve anaemic patients on haemodialysis were treated with recombinant human erythropoietin, starting with 72 IU/kg/week. The dose was doubled after 2 weeks until an increase of 2 g/dl of haemoglobin was observed. The effects on various parameters were studied during a 3-month period. Haemoglobin increased from 6.70 +/- 0.74 to 10.49 +/- 1.04 g/dl (mean +/- SD, P less than 0.001), potassium from 5.51 +/- 0.50 to 6.06 +/- 0.65 mmol/l (P less than 0.005), phosphate from 1.78 +/- 0.40 to 2.17 +/- 0.40 mmol/l (P less than 0.001) and the calcium phosphorus product from 4.3 to 5.2 (P less than 0.001). Three patients developed marked periarticular inflammation due to calcified deposits with a high calcium-phosphorus product of 6.8. An increase in arterial blood pressure was observed in three previously well-controlled hypertensive patients, one of whom developed hypertensive encephalopathy. We conclude that recombinant human erythropoietin is very effective in treating the anaemia of end-stage renal failure on haemodialysis. Regular estimations of serum potassium and phosphate are mandatory. In hypertensive individuals a further increase in blood pressure is possible.
Assuntos
Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Hemoglobinas/metabolismo , Proteínas Recombinantes/uso terapêutico , Diálise Renal , Adulto , Idoso , Anemia/sangue , Anemia/etiologia , Eritropoetina/administração & dosagem , Eritropoetina/efeitos adversos , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Periartrite/sangue , Periartrite/induzido quimicamente , Fosfatos/sangue , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversosRESUMO
Patient characteristics, clinical outcomes, and proposed pathophysiologic mechanisms are reviewed in 138 patients reported in the literature to have had ascites associated with end-stage renal disease. Contributing mechanisms may include fluid overload, peritoneal membrane changes (not necessarily related to peritoneal dialysis), hypoproteinemia, and lymphatic drainage disturbances. In 15% of cases, extensive evaluations may reveal an underlying disease. The most effective therapy may be kidney transplantation.
Assuntos
Ascite/etiologia , Falência Renal Crônica/complicações , Ascite/terapia , Humanos , Falência Renal Crônica/terapia , Diálise Peritoneal , Diálise RenalRESUMO
Whether the dopaminergic system may be involved in essential hypertension is of pathogenetic as well as therapeutic interest. Therefore, we investigated in eight hypertensive and 12 normal subjects cardiovascular, endocrine, and renal responses to fenoldopam, which has been characterized experimentally as an agonist of peripheral postsynaptic dopamine1 receptors. A single oral dose of fenoldopam, 100 mg, changed blood pressure (BP) in hypertensive subjects (from 163/103 to 147/76 mm Hg; p less than 0.01 for systolic and p less than 0.001 for diastolic BP) and normal subjects (from 121/81 to 123/65 mm Hg; p less than 0.001 for diastolic BP); percentage decreases in diastolic BP averaged -20 +/- 6 and -16 +/- 7%, respectively. Fenoldopam-induced effects on other variables were similar in the two groups. Heart rate rose (p less than 0.001) on average from 69 to 92 beats/min in hypertensive and from 64 to 84 beats/min in normal subjects. Effective renal plasma flow increased (from 552 to 765 and 634 to 937 ml/min/1.73 m2; p less than 0.01), while glomerular filtration rate tended to decrease (from 121 to 99 ml/min/1.73 m2 in the hypertensive and from 119 to 97 ml/min/1.73 m2; p less than 0.001 in the normal group). Fractional sodium clearance was elevated (from 2.8 to 5.2 and 1.7 to 3.8%; p less than 0.01), as was free water clearance (from -1.7 to 0.6 and -1.7 to 0.1 ml/min/1.73 m2; p less than 0.01). Potassium clearance was largely unchanged. Plasma renin activity increased about twofold (p less than 0.01 in normal subjects), and plasma aldosterone by 40% (NS). Plasma norepinephrine levels increased twofold to 2.5-fold (p less than 0.001), and urinary norepinephrine excretion fivefold to 10-fold (p less than 0.01). Fenoldopam-induced changes were not significantly modified by intravenous and/or oral pretreatment with the dopamine-receptor antagonist metoclopramide or the cyclooxygenase inhibitor indomethacin. These findings suggest that in humans, fenoldopam may acutely override the dopaminergic antagonism of metoclopramide given in clinical dosage and that its cardiovascular and renal effects are not prostaglandin-mediated. Although acute sympathetic stimulation may be partially antagonistic, the concomitant BP-lowering, renal vasodilating, and natriuretic actions of fenoldopam represent a desirable profile of a potential antihypertensive agent.
Assuntos
Benzazepinas/farmacologia , Hemodinâmica/efeitos dos fármacos , Hipertensão/fisiopatologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Receptores Dopaminérgicos/efeitos dos fármacos , Sistema Renina-Angiotensina/efeitos dos fármacos , Vasodilatadores/farmacologia , Administração Oral , Adulto , Benzazepinas/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Catecolaminas/sangue , Catecolaminas/urina , Feminino , Fenoldopam , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Vasodilatadores/administração & dosagemAssuntos
Falência Renal Crônica/metabolismo , Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/metabolismo , Feminino , Glucose/metabolismo , Humanos , Falência Renal Crônica/terapia , Cinética , Masculino , Pessoa de Meia-Idade , Fosfatos/metabolismo , Potássio/metabolismo , Sódio/metabolismo , Ureia/metabolismoRESUMO
The acute effects of bisoprolol 10 mg i.v., a new beta1-selective adrenoceptor antagonist, on heart rate, mean blood pressure (mBP), glomerular filtration rate (GFR), para-aminohippuric acid clearance (CPAH), sodium clearance, urine volume and plasma renin activity (PRA), were studied in 6 patients with essential hypertension. Heart rate decreased by 23%, mBP remained unchanged, and GFR decreased by 14% and CPAH by 23%. PRA was depressed on average by 25%. Urine volume and sodium clearance also declined by 9 and 13%, respectively, but the changes were not statistically significant. The fall in heart rate was significantly correlated with that in GFR and CPAH. Changes in GFR were correlated significantly with those in CPAH. The acute changes in renal function induced by bisoprolol are considered to be due to a reduction in cardiac output and increased systemic vascular resistance.
Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Rim/efeitos dos fármacos , Propanolaminas/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Bisoprolol , Pressão Sanguínea/efeitos dos fármacos , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Propanolaminas/uso terapêutico , Renina/sangue , Sódio/urinaRESUMO
The effect of captopril up to 450 mg/day on blood pressure and renal function were investigated during sustained treatment of 10 patients whose severe hypertension had not responded to previous therapy. All the patients were kept on diuretics and most of them on beta-blockers, too. A control determination of glomerular filtration rate (GFR) and para-aminohippuric acid clearance (CPAH) was performed during the prior treatment. The effect of the addition (or substitution) of captopril were assessed after an average of 25 days (short-term) and 26 weeks (long-term). Short-term treatment produced a 15.5% decrease in mean blood pressure and interindividually variable effects on renal function. On average GFR was somewhat lower and CPAH slightly higher than the control values (not significant). This pattern is quite similar to the effects of most other antihypertensive drugs. On long-term therapy GFR rose by a mean of 9% (NS) and CPAH by 17% (p less than 0.02). However, in a patient who developed a captopril-induced nephrotic syndrome, GFR dropped to 56% and CPAH to 50% of the control values. In another patient a transient rise in serum creatinine accompanied a severe drug reaction.
Assuntos
Captopril/uso terapêutico , Hipertensão/tratamento farmacológico , Prolina/análogos & derivados , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Captopril/efeitos adversos , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Circulação Renal/efeitos dos fármacos , Ácido p-Aminoipúrico/urinaRESUMO
Twenty-three patients with untreated mild to moderate essential hypertension had on the average an abnormally increased cardiovascular pressor responsiveness to exogenous norepinephrine (NE), while plasma and urinary NE, exchangeable body sodium and blood volume were normal. An increased pressor responsiveness to angiotensin II in these patients was associated with a tendency for low plasma renin activity (PRA). Compared to placebo conditions, treatment with chlorthalidone, 100 mg/day, for 6 weeks significantly decreased blood pressure and exchangeable sodium in these hypertensive patients but not in ten normal subjects; blood volume and heart rate were unchanged in both groups. Chlorthalidone induced a marked increase in PRA, but only a mild increase in angiotensin II pressor dose. In contrast, the diuretic caused a greater increase in NE pressor dose than in plasma NE in the hypertensive group, thus improving the disturbed relationship between plasma NE and NE responsiveness in these patients. No significant modification of plasma NE and NE responsiveness occurred in diuretic-treated normal subjects. In addition to sodium and the renin-angiotensin system, the sympathetic regulatory axis seems to be involved in the antihypertensive mechanism of chlorthalidone. Thiazide-like diuretics may decrease blood pressure in essential hypertension in part by lowering an abnormally high cardiovascular NE responsiveness without causing an equivalent increase in circulating NE.