RESUMO
Separate studies investigating the relationship of essential hypertension (EH) with the HLA system and with Chlamydia pneumoniae (C. pneumoniae) infection have given conflicting results. Our aim was to clarify these relationships and determine whether the HLA system and C. pneumoniae infection interact with respect to the risk for EH. An association study (110 essential hypertensives and 107 controls) was conducted in a highly homogeneous population in the Balearic Island of Majorca (Spain). Molecular typing of HLA-B and HLA-DRB and quantification of serum levels of IgG antibodies to C. pneumoniae (sIgGa-Cp) were determined. Student's t-test, chi(2)-statistics, logistic regression analysis, and general linear model ANOVA were used for statistical analysis. The results showed that EH was related with HLA-DRB3*0202 in the whole study population, and with levels of sIgGa-Cp>63.5 BU/ml in the group of individuals with sIgGa-Cp>30 BU/ml (OR (95% CI) adjusted for obesity, familial history of EH and diabetes=2.06 (1.07-3.97), P=0.03, and =4.60 (1.06-19.90), P=0.04, respectively). The association between EH and sIgGa-Cp was observed in the DRB3*0202(+) individuals, but not in the DRB3*0202(-) subgroup (OR (95% CI)=11.14 (1.92-64.54), P=0.004, and =0.98 (0.22-4.43), P=0.64, respectively (P of the Mantel-Haenszel test for homogeneity of OR=0.06)). In our population, EH was positively associated with HLA-DRB3*0202 and with high levels of sIgGa-Cp. Moreover, a significant interaction of DRB3*0202 on the effect of sIgGa-Cp was observed, as the association of EH with these antibodies depended on the presence of DRB*0202.
Assuntos
Anticorpos Antibacterianos/sangue , Chlamydophila pneumoniae/imunologia , Antígenos HLA-DR/genética , Hipertensão/sangue , Hipertensão/genética , Imunoglobulina G/sangue , Adulto , Idoso , Estudos de Casos e Controles , Infecções por Chlamydophila/complicações , Feminino , Antígenos HLA-B/genética , Humanos , Hipertensão/microbiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , EspanhaRESUMO
Numerous association studies have been performed to evaluate the relationship between the angiotensinogen gene and the essential hypertension, but their results are conflicting. The conflicting results may be explained by methodological reasons, particularly genetic differences in the population samples, phenotypic differences in the hypertensive populations analyzed, lack of appropriate control for other hypertension risk factors in some studies, or limited statistical power among many studies. Furthermore, hypertension is a public health issue of great relevance in Baleric Islands (Spain). For these reasons we performed an association study about the relationship between the M235T, T174M and G-6A diallelic polymorphisms of the angiotensinogen gene and hypertension in a population from Majorca (Balearic Islands), in which a considerable homogeneity with respect to ethnicity and environmental factors could be documented. This population was composed of 109 patients and 107 controls. Alleles of the angiotensinogen gene were determined by PCR and restriction site polymorphism analysis. The different genotypes were tested for association with dependent variables by univariate and multivariate logistic regression analysis. In the univariate analysis we found no evidence of association between the angiotensinogen gene genotypes and hypertension. This lack of association was independent of obesity, familial history of hypertension and diabetes for the genotypes of the polymorphisms M235T and G-6A; however, in the multivariate analysis the T174T174 genotype showed an almost significant positive association with hypertension [OR = 2.76 (95% confidence interval: 1.00-7.65, p = 0.05)]. The T174T174 genotype also showed a significant negative association with obesity [OR = 0.41 (95% confidence interval: 0.18-0.90, p = 0.03)] that remained after adjustment by sex, hypertension and diabetes [OR = 0.26 (95% confidence interval: 0.10-0.65, p = 0.004)]. Our results: a) are in contrast with the results from most previous studies that found a relationship of the T174M polymorphism with hypertension, as in those studies the M174 allele was responsible for the association; b) emphasize the need for rigorous control for obsesity in the studies of association between the angiotensinogen gene and hypertension; c) underscore the importance and the utility of using concrete populations to carry out studies on the genetic dissection of hypertension.
Assuntos
Angiotensinogênio/genética , Hipertensão/genética , Obesidade/genética , Polimorfismo Genético , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaAssuntos
Transplante de Rim/estatística & dados numéricos , Sistema de Registros , Diálise Renal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Prevalência , EspanhaRESUMO
Wegener's granulomatosis is a necrotizing vasculitis disorder that usually presents with clinical involvement of the upper and lower respiratory tract in association with renal disease. Although Wegener's granulomatosis can affect other systems, such as the eye, skin, joints, muscle, nerves, gastrointestinal tract and heart, cardiac involvement is traditionally believed to be rare, even though coronary vasculitis can be demonstrated at postmortem examination. We report a patient who has both respiratory and renal involvement who died unexpectedly following a silent myocardial infarct after a period of clinical improve induced by treatment with cyclophosphamide and prednisone.
Assuntos
Granulomatose com Poliangiite/complicações , Isquemia Miocárdica/etiologia , Adulto , Evolução Fatal , Granulomatose com Poliangiite/patologia , Humanos , Masculino , Isquemia Miocárdica/patologiaRESUMO
No disponible
Assuntos
Humanos , Diálise/métodos , Natação , Diálise Renal/métodos , Diálise/instrumentação , Qualidade de Vida , Colostomia/instrumentação , Equipamentos de Proteção , Cateteres de Demora , Diálise Renal/instrumentaçãoRESUMO
A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. It is a persistent remnant of the left anterior cardinal vein that usually disappears in early embryological development as a result of compression between the left atrium and the hilum of the left lung. If it is not associated with other congenital cardiac anomalies it is usually asymptomatic but has important clinical implications in some situations. In this article, we describe a patient with bilateral SVC identified on a chest radiograph by a haemodialysis central venous catheter passing through it.
Assuntos
Cateterismo , Nefropatias Diabéticas/terapia , Falência Renal Crônica/terapia , Diálise Renal , Veia Cava Superior/anormalidades , Cateteres de Demora , Humanos , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Radiografia , Ultrassonografia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/embriologiaAssuntos
Corticosteroides/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Tacrolimo/uso terapêutico , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Idoso , Creatinina/sangue , Esquema de Medicação , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/epidemiologia , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/fisiologia , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , População BrancaRESUMO
No disponible
Assuntos
Humanos , Antibioticoprofilaxia/métodos , Soluções para Diálise/farmacologia , Diálise Peritoneal/métodos , Peritonite/prevenção & controleRESUMO
La calcifilaxis es una inusual complicación de la insuficiencia renal crónica asociada a una elevada morbi-mortalidad. El caso clínico que presentamos, describeuna paciente paratiroidectomizada en 1997, que en abril de 1999 es diagnosticada de calcifilaxis tras sospecha clínica y confirmación mediante biopsia cutánea. La persistencia de niveles de PTH superiores a 400 pg/mI, junto con unas imágenes gammagráficas sospechosas de nódulos paratiroideos, determinan una nueva intervención quirúrgica (extirpándose dos nódulos), tras la cual, remite por completo la sintomatología, a pesar de que los nódulos extraídos fueron identificados como tejido tiroideo. Corroboramos el hecho de que la patogenia de la calcifilaxis es multifactorial, adquiriendo especial relevancia el uso de quelantes cálcicos (con un riesgo elevado de presentar hipercalcemia) en el tratamiento de la insuficiencia renal crónica (AU)
Calciphylaxis is an unusual complication of chronic renal failure associted with increased morbidity and mortality. This presentation is a clinical case describinga patient parathyreidectomized in 1997, followed by the condition was clinically suspected and then confirmed by skin biopsy. PTHi levels above 400 pg/ml together with scintigraphyc images suggesting parathyroid nodules resulted in the decision to try a new surgical procedure, which yielded two nodules of thyroideal tissue. After the surgery and in spite of this pathology result, the patient recovered completely from her symptoms. This corroborates the theory that the etiology of calciphylaxis is multifactorial, acquiring special relevance the use of calcium-containing phospa ¡the binders (representing a high risk of hypercalcemia)in the treatment of Chronic Renal Disease (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Calciofilaxia/etiologia , Calciofilaxia/patologia , Insuficiência Renal Crônica/complicações , Dermatopatias/etiologia , Dermatopatias/patologiaAssuntos
Angiotensinas/genética , Hipertensão/genética , Alelos , Substituição de Aminoácidos , Mapeamento Cromossômico , Métodos Epidemiológicos , Etnicidade/genética , Feminino , Previsões , Regulação da Expressão Gênica , Heterogeneidade Genética , Predisposição Genética para Doença , Técnicas Genéticas , Genótipo , Haplótipos/genética , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Desequilíbrio de Ligação , Masculino , Mutação de Sentido Incorreto , Fenótipo , Polimorfismo Genético , Regiões Promotoras Genéticas , Sistema Renina-Angiotensina/fisiologia , Risco , Estatísticas não ParamétricasAssuntos
Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Micoses/prevenção & controle , Diálise Peritoneal/efeitos adversos , Peritonite/prevenção & controle , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antifúngicos/administração & dosagem , Infecções Bacterianas/epidemiologia , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/terapia , Suscetibilidade a Doenças , Esquema de Medicação , Avaliação de Medicamentos , Feminino , Fluconazol/administração & dosagem , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/etiologia , Micoses/microbiologia , Peritonite/epidemiologia , Peritonite/etiologia , Peritonite/microbiologia , Espanha/epidemiologia , Resultado do TratamentoRESUMO
Calciphylaxis is an unusual complication of chronic renal failure associated with increased morbidity and mortality. This presentation is a clinical case describing a patient parathyreidectomized in 1997, followed by the condition was clinically suspected and then confirmed by skin biopsy. PTHi levels above 400 pg/ml together with scintigraphic images suggesting parathyroid nodules resulted in the decision to try a new surgical procedure, which yielded two nodules of thyroideal tissue. After the surgery and in spite of this pathology result, the patient recovered completely from her symptoms. This corroborates the theory that the etiology of calciphylaxis is multifactorial, acquiring special relevance the use of calcium-containing phosphathe binders (representing a high risk of hypercalcemia) in the treatment of Chronic Renal Disease.
Assuntos
Calciofilaxia/patologia , Dermatopatias/patologia , Calciofilaxia/etiologia , Feminino , Humanos , Falência Renal Crônica/complicações , Pessoa de Meia-Idade , Dermatopatias/etiologiaRESUMO
El citomegalovirus (CMV) es el mayor patógeno viral después de un trasplante renal. Se estima que el CMV causa enfermedad sintomática en un porcentaje que varía según los trabajos desde un 8-35 por ciento y ocasiona la muerte en el 2 por ciento de los pacientes. Los factores de riesgo de la infección por CMV son el estado serológico del donante y receptor, el tratamiento inmunosupresor y la carga viral. La prevención de la infección y/o enfermedad por CMV en el trasplante renal se puede plantear mediante tres estrategias: profilaxis universal, profilaxis dirigida o tratamiento precoz.Hay tres tipos de medidas profilácticas para prevenir la infección y enfermedad por CMV en los pacientes trasplantados que deben utilizarse de forma combinada: la disminución en el riesgo de adquisición o reactivación del virus, la inducción de protección inmunológica (vacunación e inmunoprofilaxis pasiva con inmunoglobulinas inespecíficas o hiperinmunes) y ¡a utilización de fármacos antivirales; los fármacos utilizados en la profilaxis han sido: aciclovir oral, ganciclovir i.v., oral y valaciclovir. En base a la evidencia disponible se recomienda realizar profilaxis en los siguientes grupos, dependiendo del estado serológico del donante y receptor: - Donante CMV+ y receptor CMV-- (D+/R-): profilaxis recomendada.-- Donante CMV- y receptor CMV+ (D-/R+): depende.- Donante CMV+ y receptor CMV+ (D+/R+): depende de la inmunosupresión.-- Donante CMV- y receptor CMV'- (D-/R-): no hacer profilaxis (AU)