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1.
Zdr Varst ; 61(2): 115-123, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35432614

RESUMO

Introduction: When introducing and using technology in nursing, there is a danger that too much focus is placed on technology over caring for patients. The 'Technological competency as caring in nursing' theory can facilitate technology in caring, but the theory needs to be described, analysed and evaluated before it is used. The purpose of the literature review was to determine the possibility of applying the theory in education, research and practice, and whether the theory could be used to guide research into the use of electronic nursing record systems. Methods: A literature search was conducted in PubMed, CINAHL, ScienceDirect, Google Scholar and Google Books, and supplemented with manual searching using the keywords 'Locsin', 'technology', 'caring' and 'nursing theory'. The criteria for inclusion were fully accessible articles and books in English on the relevant topics. The review process is shown in a PRISMA diagram. A hierarchy of evidence was used to evaluate the relative strength of the results. Pajnkihar's model was used to describe, analyse and evaluate the theory. Results: A total of 26 hits were included in the final analysis. The theory in question meets the criteria of clarity, simplicity and complexity, adequacy, importance and significance; it can be tested; and it is useful in patient care that employs technology. Discussion and conclusion: The theory is useful in nursing education, research and practice. The theory will be used to guide research on the perception of technological competency and care of internal medicine patients by nurses when using the electronic nursing record system in three Slovenian hospitals.

2.
Blood Purif ; 51(1): 15-22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33784665

RESUMO

BACKGROUND: Monitoring of arteriovenous (AV) fistula to detect hemodynamically important stenosis is crucial for the prevention of AV fistula thrombosis. The aim of our study was to analyze the importance of dialysis dose (Kt/V) during online postdilution hemodiafiltration (HDF) for early detection of AV fistula stenosis. METHODS: Hemodialysis patients with AV fistula were included in this study. We compared a group of 44 patients who have undergone fistulography and subsequently percutaneous transluminal angioplasty (PTA) of significant AV fistula stenosis (active group) with a group of 44 age- and sex-matched patients without PTA (control group). Observational time in both groups was the same. RESULTS: All patients had postdilution online HDF using a F5008 dialysis machine, which can measure online single-pool Kt/V. All data were analyzed during the performance of 2056 HDF procedures. In the active group, we found statistically significantly lower values of Kt/V, all 8 weeks before PTA. In the active group, there was a significant improvement in Kt/V in the first (p < 0.001) and second week (p = 0.049) after PTA. Three and 8 weeks after PTA, we did not find any statistically significant difference in Kt/V between both groups (p = 0.114; p = 0.058). Patients in the active group had statistically significantly lower substitution volumes and blood pump flow rates during HDF over the whole observation period before and after PTA. In contrast, there were no differences in venous pressure in the dialysis circuit between both groups throughout the observation period. CONCLUSION: In hemodialysis patients with AV fistula, treated with online HDF, routine measurements of Kt/V during each HDF are a beneficial, quick, and straightforward method for early detection of hemodynamically significant AV fistula stenosis.


Assuntos
Fístula Arteriovenosa/diagnóstico , Diálise Renal , Idoso , Angioplastia , Constrição Patológica/diagnóstico , Diagnóstico Precoce , Feminino , Hemodiafiltração/efeitos adversos , Hemodiafiltração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/métodos
3.
Clin Nephrol ; 96(1): 1-5, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643484

RESUMO

BACKGROUND: The prevalence of chronic kidney disease (CKD) is increasing on a global scale. Patients with CKD have a reduced quality of life and are more likely to develop significant cardiovascular disease, most commonly coronary artery disease (CAD). Left main coronary artery disease (LMCAD) is one of the most severe forms of CAD, where revascularization is needed. The aim of the study was to determine the impact of CKD on the mortality of patients after undergoing percutaneous coronary intervention (PCI) for the acute coronary syndrome (ACS) due to LMCAD. MATERIALS AND METHODS: 210 Caucasian patients (142 male; 67.6%, mean age 69.2 ± 11.3 years) with ACS due to LMCAD who underwent primary PCI were included in this retrospective study. Basic demographic and laboratory data were recorded. Patients were divided into two groups by their estimated glomerular filtration rate (eGFR). Those in the CKD group had eGFR ≤ 60 mL/min/1.73m2 (n = 82), and those in the non-CKD group had eGFR > 60 mL/min/1.73m2 (n = 128). RESULTS: The mean survival time of patients in the CKD group was 1,550 ± 1,393 days, compared to the non-CKD group of 2,149 ± 1,235 days. Kaplan-Meier survival analysis showed a statistically significant (log-rank, p < 0.0005) difference in mortality for patients in the CKD group compared to those in the non-CKD group. Cox-regression analysis showed a correlation between CKD and mortality (B = 0.541, p = 0.036), independent of arterial hypertension, diabetes mellitus, total cholesterol, and triglycerides. CONCLUSION: CKD is an independent risk factor for increased mortality after PCI due to an ACS in LMCAD.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Insuficiência Renal Crônica , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Taxa de Filtração Glomerular , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Qualidade de Vida , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
Clin Nephrol ; 96(1): 43-48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643490

RESUMO

BACKGROUND: Cystatin C (cysC) is freely filtered in the glomeruli, and its serum concentration is independent of muscle mass, diet, gender, or age. In patients with chronic kidney disease (CKD), cysC is associated with advanced atherosclerosis and increased arterial stiffness. The purpose of this study was to define possible associations between arterial stiffness parameters and cysC in patients without CKD. MATERIALS AND METHODS: The study included 111 non-CKD patients. Basic demographic and laboratory data were recorded. Arterial stiffness was measured by applanation tonometry (sphygmocor, Australia). RESULTS: Mean age of the patients was 64.3 ± 9.4 years, 65.8% were men. Most common co-morbidities were arterial hypertension (AH) (n = 86, 77.5%), hyperlipidemia (n = 64, 57.7%), and diabetes mellitus (DM) (n = 22; 19.8%). Mean creatinine was 77.7 ± 13.8 µmol/L (range 49 - 108), estimated GFR 81.3 ± 9.4 mL/min/1.73m2 (range 62 - 90), and cysC 0.94 ± 0.18 mg/L (range 0.67 - 1.63). Mean carotid-femoral pulse wave velocity (cfPWV) was 10.1 ± 2.4 m/s (range 6.2 - 16.8), subendocardial viability ratio (SEVR) 165.7 ± 36.1% (range 92 - 299), ejection duration (ED) 33.8 ± 4.4 ms (range 22 - 46), and pulse pressure (PP) 46.6 ± 14.8 mmHg (range 17 - 94). A statistically significant association was found between cysC and cfPWV (r = 0.472, p < 0.001), SEVR (r = -0.316, p < 0.001), ED (r = 0.217, p = 0.025), and pulse pressure (PP) (r = 0.241, p = 0.012). Multiple regression analysis between arterial stiffness parameters and cysC, age, male gender, AH, DM, hyperlipidemia, and eGFR confirmed a statistically significant and independent association between cysC and cfPWV (ß = 0.220, p = 0.038), between cysC and SEVR (ß = -0.278, p = 0.017), and between cysC and ED (ß = 0.241, p = 0.045). CONCLUSION: Elevated cysC is associated with increased cfPWV, increased ED, and decreased SEVR.


Assuntos
Insuficiência Renal Crônica , Rigidez Vascular , Idoso , Cistatina C , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Insuficiência Renal Crônica/diagnóstico
5.
Clin Nephrol ; 96(1): 31-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643488

RESUMO

BACKGROUND: Acute myeloid leukemia (AML) is an aggressive hematological cancer that involves myeloid cells. Elderly patients with comorbidities and poor performance status (PS) receive treatment with hypomethylating agents or supportive care. Several models are available to predict treatment-related mortality and they all primarily focus on PS. Little is known about the impact of chronic kidney disease (CKD) on survival in elderly patients with AML. MATERIALS AND METHODS: We performed a retrospective analysis of 81 patients (51.9% male) aged over 65 years when the diagnosis of AML was established. The median observation period lasted 108 days (IQR 292, maximum 1,169). Patients' documentation was examined for previous illnesses, PS was calculated, basic laboratory blood tests and a bone marrow biopsy were done. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. RESULTS: The median age of patients was 75 years (IQR 14, maximum 93). The mean eGFR was 59.5 ± 24.0 mL/min/1.73m2. CKD was present in almost half of patients (49.4%). Altogether, 69 (85.2%) patients died during the observation period. Kaplan-Meier survival analysis showed statistically lower survival for CKD patients (log-rank χ2 = 6.736; p = 0.009). Cox regression model, adjusted for age, comorbidities, and treatment, revealed the main predictors for patient survival to be PS, AML type, and blast percentage. CONCLUSION: Our results indicate that elderly patients with AML have worse survival when diagnosed with CKD, however CKD was not one of the main predictors of patient survival.


Assuntos
Leucemia Mieloide Aguda , Insuficiência Renal Crônica , Adolescente , Idoso , Feminino , Taxa de Filtração Glomerular , Humanos , Rim , Leucemia Mieloide Aguda/diagnóstico , Masculino , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos
6.
Clin Nephrol ; 96(1): 68-73, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643494

RESUMO

BACKGROUND: Optimal fluid management is a physician's everyday challenge in patients on maintenance hemodialysis (HD). Bioimpedance spectroscopy (BIS) is a non-invasive method to estimate body composition, including estimates of fluid overload (FO). Our study aimed to analyze the association between FO and the mortality rate in HD patients. MATERIALS AND METHODS: We performed a retrospective single-center cohort study in 92 HD patients. The body composition was measured before HD using the portable whole-body BIS device Body Composition Monitor (BCM). We have analyzed the mortality rates of HD patients in two FO groups, a standard definition FO group (> 1.1 L), and a severe FO group (> 2.5 L) and compared them to mortality rates of patients without FO or without severe FO, respectively. RESULTS: The mean age of patients was 64.3 ± 13.0 years, mean dialysis vintage 64 months, 60.9% were men. 68 (73.9%) patients had FO of > 1.1 L and 30 (32.6%) had FO of > 2.5 L. During the follow-up period of 1,020 ± 417 days, 29 (31.5%) patients died. Kaplan-Meier survival analysis showed that patients with FO > 2.5 L had worse survival (p = 0.039). In a Cox regression model, which included FO > 2.5 L, age, dialysis vintage, hemoglobin, C-reactive protein, and albumin, only FO > 2.5 L and advanced age turned out to be predictors of death (p = 0.044 and p = 0.001, respectively). CONCLUSION: HD patients with FO > 2.5 L before HD have poorer survival than patients with normohydration or lower overhydration.


Assuntos
Falência Renal Crônica , Desequilíbrio Hidroeletrolítico , Idoso , Composição Corporal , Estudos de Coortes , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos
7.
Clin Nephrol ; 96(1): 85-88, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643497

RESUMO

BACKGROUND: Lung ultrasound (LUS) is a non-invasive technique for estimating extravascular lung water in patients with end-stage renal disease and heart diseases. In this study, we examined an association between the severity of lung congestion as detected by LUS B-lines (LUS comets), anemia, and serum biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) in peritoneal dialysis (PD) patients. MATERIALS AND METHODS: 19 patients, who were treated with PD in our dialysis center were enrolled. On the day of their routine check-up, we performed a lung auscultation, LUS on 28 typical locations and determined blood levels of hemoglobin and NT-proBNP. RESULTS: The average age of patients was 54 (range 30 - 71) years, the average duration of PD treatment was 53 (range 10 - 194) months, 63% (12) of the patients were male. Nine (47.4%) patients had peripheral edema, and only 1 (5.3%) patient had inspiratory crackles. Using LUS, we found mean 17 (range 1 - 87) lung comets. Mean hemoglobin level was 108.6 g/L (SD ± 10.4), mean NT-proBNP level 1,151 pmol/L (SD ± 1,077). We found a statistically significant correlation between the number of lung comets and hemoglobin level (r = -0.655; p = 0.002) and NT-proBNP (r = 0.759; p < 0.0001). Multiple regression analysis with the number of lung comets as dependent variable and hemoglobin and NT-proBNP levels as independent variables confirmed a statistically significant association between the number of lung comets and NT-proBNP (ß = 0.572; p = 0.009). CONCLUSION: In PD patients, the number of LUS comets is associated with hemoglobin and NT-proBNP.


Assuntos
Peptídeo Natriurético Encefálico , Diálise Peritoneal , Adulto , Idoso , Biomarcadores , Feminino , Hemoglobinas , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos , Diálise Peritoneal/efeitos adversos
8.
Kidney Int Rep ; 6(9): 2392-2403, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34514200

RESUMO

INTRODUCTION: The clinical-histologic correlation in diabetic nephropathy is not completely known. METHODS: We analyzed nephrectomy specimens from 90 patients with diabetes and diverse degrees of proteinuria and glomerular filtration rate (GFR). RESULTS: Thirty-six (40%) subjects had normoalbuminuria, 33 (37%) microalbuminuria, and 21 (23%) non-nephrotic proteinuria. Mean estimated GFR (eGFR) was 65±23 (40% <60 ml/min per 1.73 m2). About 170 glomeruli per patient were analyzed, and all samples included vascular tissue. Six subjects (7%) were classified in diabetic nephropathy class I, 61 (68%) in class II-a, 13 (14%) in class II-b, 9 (10%) class III, and 1 (1%) in class IV. Eighty percent to 90% of those with normoalbuminuria or microalbuminuria were classified in class II-a or II-b and <10% in class III; 52% of those with proteinuria were in class II-a, 15% in class II-b, and 19% in class III. Nodular sclerosis (57%) and mesangial expansion (15%) were more frequent in cases with proteinuria than in normoalbuminuria (28% and 8%; P = 0.028 and 0.017). About 20% to 30% of all cases, regardless the level of albuminuria or proteinuria or the histologic class had tubular atrophy, interstitial fibrosis, or inflammation in >10% to 20% of the sample. Moderate hyalinosis and arteriolar sclerosis were observed in 80% to 100% of cases with normoalbuminuria, microalbuminuria, proteinuria, as well as in class I, II, or III. CONCLUSIONS: Weak correspondence between analytical parameters and kidney histology was found. Thus, disease may progress undetected from the early clinical stages of the disease. Finally, vascular damage was a very common finding, which highlights the role of ischemic intrarenal disease in diabetes.

9.
Clin Kidney J ; 14(8): 1861-1870, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34345408

RESUMO

In the vast majority of cases, glomerular filtration rate (GFR) is estimated using serum creatinine, which is highly influenced by age, sex, muscle mass, body composition, severe chronic illness and many other factors. This often leads to misclassification of patients or potentially puts patients at risk for inappropriate clinical decisions. Possible solutions are the use of cystatin C as an alternative endogenous marker or performing direct measurement of GFR using an exogenous marker such as iohexol. The purpose of this review is to highlight clinical scenarios and conditions such as extreme body composition, Black race, disagreement between creatinine- and cystatin C-based estimated GFR (eGFR), drug dosing, liver cirrhosis, advanced chronic kidney disease and the transition to kidney replacement therapy, non-kidney solid organ transplant recipients and living kidney donors where creatinine-based GFR estimation may be invalid. In contrast to the majority of literature on measured GFR (mGFR), this review does not include aspects of mGFR for research or public health settings but aims to reach practicing clinicians and raise their understanding of the substantial limitations of creatinine. While including cystatin C as a renal biomarker in GFR estimating equations has been shown to increase the accuracy of the GFR estimate, there are also limitations to eGFR based on cystatin C alone or the combination of creatinine and cystatin C in the clinical scenarios described above that can be overcome by measuring GFR with an exogenous marker. We acknowledge that mGFR is not readily available in many centres but hope that this review will highlight and promote the expansion of kidney function diagnostics using standardized mGFR procedures as an important milestone towards more accurate and personalized medicine.

10.
Case Rep Nephrol Dial ; 11(2): 129-135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34250030

RESUMO

Statins or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors are a mainstay of cardiovascular disease therapy. In addition to their lipid-lowering capabilities, they exhibit several pleiotropic effects. Their adverse reactions such as myalgias are not uncommon, but in rare cases, the resulting rhabdomyolysis can be fatal. Recently, more insight has been brought into the pathogenesis of statin-induced rhabdomyolysis, and immune-mediated necrotizing myopathies are diagnosed more frequently. We present a case of a female patient who was on chronic rosuvastatin therapy and developed necrotizing myopathy. The disease progressed to acute kidney and liver injury. We discontinued the drug, started supportive measures, and initiated renal replacement therapy with a high cutoff dialysis membrane once. Her recovery was prompt, with a normal control electromyography 2 weeks after discharge.

11.
World J Diabetes ; 12(7): 975-996, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34326949

RESUMO

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

12.
Pharmaceuticals (Basel) ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208285

RESUMO

Diabetes mellitus is a global health issue and main cause of chronic kidney disease. Both diseases are also linked through high cardiovascular morbidity and mortality. Diabetic kidney disease (DKD) is present in up to 40% of diabetic patients; therefore, prevention and treatment of DKD are of utmost importance. Much research has been dedicated to the optimization of DKD treatment. In the last few years, mineralocorticoid receptor antagonists (MRA) have experienced a renaissance in this field with the development of non-steroidal MRA. Steroidal MRA have known cardiorenal benefits, but their use is limited by side effects, especially hyperkalemia. Non-steroidal MRA still block the damaging effects of mineralocorticoid receptor overactivation (extracellular fluid volume expansion, inflammation, fibrosis), but with fewer side effects (hormonal, hyperkalemia) than steroidal MRA. This review article summarizes the current knowledge and newer research conducted on MRA in DKD.

13.
Genes (Basel) ; 12(6)2021 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071541

RESUMO

The ten most statistically significant estimated glomerular filtration rate (eGFRcrea)-associated loci from genome-wide association studies (GWAs) are tested for associations with chronic kidney disease (CKD) in 208 patients, including dialysis-independent CKD and dialysis-dependent end-stage renal disease (kidney failure). The allele A of intergenic SNP rs2453533 (near GATM) is more frequent in dialysis-independent CKD patients (n = 135, adjusted p = 0.020) but not dialysis-dependent kidney failure patients (n = 73) compared to healthy controls (n = 309). The allele C of intronic SNP rs4293393 (UMOD) is more frequent in healthy controls (adjusted p = 0.042) than in CKD patients. The Allele T of intronic SNP rs9895661 (BCAS3) is associated with decreased eGFRcys (adjusted p = 0.001) and eGFRcrea (adjusted p = 0.017). Our results provide further evidence of a genetic difference between dialysis-dialysis-independent CKD and dialysis-dependent kidney failure, and add the GATM gene locus to the list of loci associated only with dialysis-independent CKD. GATM risk allele carriers in the dialysis-independent group may have a genetic susceptibility to higher creatinine production rather than increased serum creatinine due to kidney malfunction, and therefore, do not progress to dialysis-dependent kidney failure. When using eGFRcrea for CKD diagnosis, physicians might benefit from information about creatinine-increasing loci.


Assuntos
Amidinotransferases/genética , Polimorfismo de Nucleotídeo Único , Insuficiência Renal Crônica/genética , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/terapia , Uromodulina/genética
14.
Am J Nephrol ; 52(5): 404-411, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975308

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) is a risk factor for cardiovascular and all-cause mortality. Recognition of high-risk patients is important and could lead to a different approach and better treatment. The CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF), but it is also a useful predictor of outcome in other cardiovascular conditions, independent of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in predicting cardiovascular and all-cause mortality in CKD patients. METHODS: Stable nondialysis CKD patients were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed till the same end date, until kidney transplantation or until their death. RESULTS: Eighty-seven CKD patients were included (60.3 ± 12.8 years, 66% male). Mean follow-up time was 1,696.5 ± 564.6 days. During the follow-up, 21 patients died and 11 because of cardiovascular reasons. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular and all-cause mortality. In multivariate Cox regression analysis, in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, hemoglobin, high-sensitivity C-reactive protein, and intact parathyroid hormone were included, CHA2DS2-VASc score was an independent predictor of cardiovascular (HR: 2.04, CI: 1.20-3.45, p = 0.008) and all-cause mortality (HR: 2.06, CI: 1.43-2.97, p = 0.001). The same was true after adding total cholesterol, triglycerides, and smoking status to both the analyses. CONCLUSION: The CHA2DS2-VASc score is a simple, practical, and quick way to identify the risk for cardiovascular and all-cause mortality in CKD patients.


Assuntos
Doenças Cardiovasculares/mortalidade , Insuficiência Renal Crônica/complicações , Idoso , Doenças Cardiovasculares/etiologia , Causas de Morte , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/mortalidade , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
15.
Biomedicines ; 9(2)2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33670423

RESUMO

Chronic kidney disease (CKD) is one of the major health problems of the modern age. It represents an important public health challenge with an ever-lasting rising prevalence, which reached almost 700 million by the year 2017. Therefore, it is very important to identify patients at risk for CKD development and discover risk factors that cause the progression of the disease. Several studies have tackled this conundrum in recent years, novel markers have been identified, and new insights into the pathogenesis of CKD have been gained. This review summarizes the evidence on markers of inflammation and their role in the development and progression of CKD. It will focus primarily on cytokines, chemokines, and cell adhesion molecules. Nevertheless, further large, multicenter studies are needed to establish the role of these markers and confirm possible treatment options in everyday clinical practice.

16.
BMC Cardiovasc Disord ; 21(1): 33, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441117

RESUMO

INTRODUCTION: Functional changes in peripheral arterial disease (PAD) could play a role in higher cardiovascular risk in these patients. METHODS: 123 patients who underwent elective coronary angiography were included. Ankle-brachial index (ABI) was measured and arterial stiffness parameters were derived with applanation tonometry. RESULTS: 6 patients (4.9%) had a previously known PAD (Rutherford grade I). Mean ABI was 1.04 ± 0.12, mean subendocardial viability ratio (SEVR) 166.6 ± 32.7% and mean carotid-femoral pulse wave velocity (cfPWV) 10.3 ± 2.4 m/s. Most of the patients (n = 81, 65.9%) had coronary artery disease (CAD). There was no difference in ABI among different degrees of CAD. Patients with zero- and three-vessel CAD had significantly lower values of SEVR, compared to patients with one- and two-vessel CAD (159.5 ± 32.9%/158.1 ± 31.5% vs 181.0 ± 35.2%/166.8 ± 27.8%; p = 0.048). No significant difference was observed in cfPWV values. Spearman's correlation test showed an important correlation between ABI and SEVR (r = 0.196; p = 0.037) and between ABI and cfPWV (r = - 0.320; p ≤ 0.001). Multiple regression analysis confirmed an association between cfPWV and ABI (ß = - 0.210; p = 0.003), cfPWV and mean arterial pressure (ß = 0.064; p < 0.001), cfPWV and age (ß = 0.113; p < 0.001) and between cfPWV and body mass index (BMI (ß = - 0.195; p = 0.028), but not with arterial hypertension, dyslipidemia, diabetes mellitus or smoking status. SEVR was not statistically significantly associated with ABI using the same multiple regression model. CONCLUSION: Reduced ABI was associated with increased cfPWV, but not with advanced CAD or decreased SEVR.


Assuntos
Índice Tornozelo-Braço , Velocidade da Onda de Pulso Carótido-Femoral , Isquemia Miocárdica/diagnóstico , Doença Arterial Periférica/diagnóstico , Rigidez Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Estudos Transversais , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco
17.
Mol Biol Rep ; 47(12): 9865-9882, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33170426

RESUMO

The kidney is a complex organ, comprised primarily of glomerular, tubular, mesangial, and endothelial cells, and podocytes. The fact that renal cells are terminally differentiated at 34 weeks of gestation is the main obstacle in regeneration and treatment of acute kidney injury or chronic kidney disease. Furthermore, the number of chronic kidney disease patients is ever increasing and with it the medical community should aim to improve existing and develop new methods of renal replacement therapy. On the other hand, as polypharmacy is on the rise, thought should be given into developing new ways of testing drug safety. A possible way to tackle these issues is with isolation and culture of renal cells. Several protocols are currently described to isolate the desired cells, of which the most isolated are the proximal tubular epithelial cells. They play a major role in water homeostasis, acid-base control, reabsorption of compounds, and secretion of xenobiotics and endogenous metabolites. When exposed to ischemic, toxic, septic, or obstructive conditions their death results in what we clinically perceive as acute kidney injury. Additionally, due to renal cells' limited regenerative potential, the profibrotic environment inevitably leads to chronic kidney disease. In this review we will focus on human proximal tubular epithelial cells. We will cover human kidney culture models, cell sources, isolation, culture, immortalization, and characterization subdivided into morphological, phenotypical, and functional characterization.


Assuntos
Técnicas de Cultura de Células/métodos , Células Epiteliais/citologia , Túbulos Renais Proximais/citologia , Células Cultivadas , Humanos
18.
Antioxidants (Basel) ; 9(10)2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-32992565

RESUMO

Diabetes prevalence is increasing worldwide, especially through the increase of type 2 diabetes. Diabetic nephropathy occurs in up to 40% of diabetic patients and is the leading cause of end-stage renal disease. Various factors affect the development and progression of diabetic nephropathy. Hyperglycaemia increases free radical production, resulting in oxidative stress, which plays an important role in the pathogenesis of diabetic nephropathy. Free radicals have a short half-life and are difficult to measure. In contrast, oxidation products, including lipid peroxidation, protein oxidation, and nucleic acid oxidation, have longer lifetimes and are used to evaluate oxidative stress. In recent years, different oxidative stress biomarkers associated with diabetic nephropathy have been found. This review summarises current evidence of oxidative stress biomarkers in patients with diabetic nephropathy. Although some of them are promising, they cannot replace currently used clinical biomarkers (eGFR, proteinuria) in the development and progression of diabetic nephropathy.

19.
Ren Fail ; 42(1): 978-986, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32972284

RESUMO

BACKGROUND: Hyperuricemia is a state in which the serum levels of uric acid are elevated. As such it has a pronounced effect on vascular and renal function with their consequences, while also showing some antioxidant effects that show to be beneficial. SUMMARY: Hyperuricemia has shown to have a J-shaped relationship with mortality, is frequently associated with development and progression of heart and kidney disease, and is correlated with malnutrition-inflammation-atherosclerosis syndrome, although several Mendelian studies have failed to show an association with morbidity and mortality. Hyperuricemia is usually associated with gout flares and tophi development but can also present as asymptomatic hyperuricemia. It is still uncertain whether asymptomatic hyperuricemia is an independent risk factor for cardiovascular or renal disease and as such its treatment is questionable. KEY MESSAGES: Some possible tools for future decision making are the use of noninvasive techniques such as pulse wave analysis, urinary sediment analysis, and joint ultrasound, which could help identify individuals with asymptomatic hyperuricemia that could benefit from urate lowering therapy most.


Assuntos
Gota/etiologia , Hiperuricemia/complicações , Rim/metabolismo , Miocárdio/metabolismo , Doenças Cardiovasculares/etiologia , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/terapia , Insuficiência Renal Crônica/etiologia , Ácido Úrico/sangue
20.
Eur J Case Rep Intern Med ; 7(4): 001526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32309263

RESUMO

Amiodarone is an antiarrhythmic drug, in use from the 1960s, which acts on potassium transport in myocytes, causing a lengthening of the action potential and refractory period. Even though it is broadly prescribed, its use is limited by a relatively high occurrence of adverse reactions such as lung, thyroid or hepatic disease, skin changes and so on. The authors report a case of a female patient who was admitted due to chest pain. Due to the bluish skin pigmentation, other causes of amiodarone toxicity were investigated, and hyperthyroidism was detected. After amiodarone discontinuation and specific therapy, thyroid function returned to normal. LEARNING POINTS: Blue pigmentation of facial skin is an uncommon adverse effect of chronic amiodarone therapy that occurs in less than 3% of patients.When a patient is on chronic amiodarone therapy, signs of toxicity, such as hyperthyroidism, lung injury or hepatic disease, should be investigated.Regular liver and thyroid function tests and chest x-rays should be carried out on follow-up after initiation of amiodarone.

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