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1.
Intern Med ; 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34393162

RESUMO

A 68-year-old woman developed systemic blisters while receiving treatment for nephrotic syndrome. As she also developed marked liver dysfunction and disseminated intravascular coagulation, she was admitted to our hospital. She was diagnosed with varicella zoster virus (VZV) infection. Treatment was administered in the intensive-care unit, but the patient died on day 24 post-admission after severe VZV infection. A post-mortem examination showed micro-abscesses and necrosis caused by varicella zoster infection in multiple organs, including the liver, kidneys, and gastrointestinal tract. Because VZV infection can become severe in immunocompromised patients, careful consideration is needed for the prevention and treatment of the viral infection.

2.
Nutrients ; 12(9)2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899702

RESUMO

Educational hospitalization of patients with chronic kidney disease (CKD) may slow the progression of renal dysfunction. However, the educational aspect that is more effective has not been identified to date. In this study, patients with CKD were evaluated for gustatory threshold for salty taste and received augmented salt reduction guidance under educational hospitalization at Nagasaki University Hospital from October 2016. In total, 277 eligible patients were enrolled and hospitalized from 2012 to 2019 (mean age of 69.2 years; men comprised 62.1%). We compared 141 patients (Group A) who were educated in the hospital after October 2016 and 136 patients (Group B) who received standard education in the hospital before October 2016. The changes in the estimated glomerular filtration rate (ΔeGFR) after hospitalization and dialysis induction rate within one year after hospitalization were evaluated. The ΔeGFR was significantly improved in Group A compared to Group B (A: 1.05 mL/min/1.73 m2/month, B: 0.55 mL/min/1.73 m2/month; p = 0.02). The dialysis induction rate was significantly lower in Group A than in Group B (A: 8.5%, B: 15.5%; p = 0.001). These trends were also observed by multivariate analyses. In conclusion, educational hospitalization with enhanced salt reduction guidance may reduce the risk of end-stage renal disease.


Assuntos
Dieta Hipossódica/psicologia , Falência Renal Crônica/prevenção & controle , Educação de Pacientes como Assunto/métodos , Insuficiência Renal Crônica/psicologia , Sódio na Dieta/análise , Idoso , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Hospitalização , Humanos , Falência Renal Crônica/etiologia , Masculino , Análise Multivariada , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Comportamento de Redução do Risco , Limiar Gustativo
3.
CEN Case Rep ; 9(4): 375-379, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32506365

RESUMO

Bartter syndrome and Gitelman syndrome (GS) are autosomal recessive disorders usually caused by homozygous or compound heterozygous mutations in causative genes. In some patients, these two syndromes cannot be discriminated based on clinical features or mutation type; thus, a single disease concept, salt-losing tubulopathies (SLTs), has been used instead. Despite the existence of several SLT causative genes, cases of digenic heterozygous mutations in two different genes are extremely rare. Here, we report the case of a 36-year-old woman with renal insufficiency and hypokalemia caused by an SLT. To evaluate the SLT phenotype, we performed next-generation sequencing (NGS) with a gene panel including SLC12A3, SLC12A1, CLCNKB, and CLCNKA as well as laboratory examinations and diuretic loading tests. The results of the diuretic loading tests were consistent with a GS phenotype, while the NGS results showed that the patient had heterozygous mutations in SLC12A1 and CLCNKB. Both genes have been associated with BS, suggesting that the SLT was caused by digenic heterozygous mutations in two different genes. To date, only a few SLT cases caused by digenic heterozygous mutations in two different genes have been reported. The digenic SLT phenotype in the patient was presumably accelerated by moderate renal insufficiency.


Assuntos
Síndrome de Bartter/diagnóstico , Síndrome de Bartter/genética , Síndrome de Gitelman/diagnóstico , Insuficiência Renal/complicações , Adulto , Síndrome de Bartter/tratamento farmacológico , Canais de Cloreto/genética , Diagnóstico Diferencial , Quimioterapia Combinada , Febuxostat/administração & dosagem , Febuxostat/uso terapêutico , Feminino , Síndrome de Gitelman/genética , Supressores da Gota/administração & dosagem , Supressores da Gota/uso terapêutico , Heterozigoto , Humanos , Hiperuricemia/etiologia , Hipopotassemia/etiologia , Mutação , Fenótipo , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Membro 1 da Família 12 de Carreador de Soluto/genética , Resultado do Tratamento
4.
BMC Nephrol ; 21(1): 195, 2020 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448180

RESUMO

BACKGROUND: Fibrillary glomerulonephritis (FGN) is distinguished from amyloidosis by thicker fibrils and the lack of staining with histochemical dyes typically reactive with amyloid. However, congophilic FGN has been proposed recently and adding laser microdissection followed by mass spectrometry (LMD/MS) to conventional pathological methods would be helpful to diagnose FGN. Here, we report a patient initially diagnosed with FGN whose final pathological diagnosis was changed to immunoglobulin heavy-and-light-chain amyloidosis (AHL) after LMD/MS. CASE PRESENTATION: A 75-year-old male developed nephrotic syndrome. Protein electrophoresis showed IgM κ type M proteinemia and he was diagnosed with IgM monoclonal gammopathy. A renal biopsy was performed and pathological examination showed marked periodic acid-Schiff-positive enlargement of the mesangial region and silver stain positivity, but weak direct fast scarlet staining. Immunofluorescence analysis showed monoclonal deposition of IgM-κ chain in the glomerulus. Under electron microscopy, the fibrils were about 20 nm in diameter, which was thicker than typical amyloid fibrils. Based on these findings, the patient was diagnosed with FGN. Although cyclophosphamide and prednisolone were administered, his renal function deteriorated and progressed to end stage renal disease requiring maintenance hemodialysis. As congophilic FGN has been recognized since 2018, Congo red staining and LMD/MS were performed. The Congo red staining was positive and LMD/MS results indicated that this was a case of AHL. CONCLUSIONS: We reported a case of µ and κ chain AHL resembling FGN requiring LMD/MS for definitive diagnosis. Since FGN and amyloidosis exhibit pathological findings, even if Congo red staining is positive, LMD/MS needs to be considered in cases atypical pathological findings, such as silver stain positivity or thicker fibrils.


Assuntos
Glomerulonefrite/diagnóstico , Cadeias Pesadas de Imunoglobulinas/metabolismo , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Imunoglobulina M/metabolismo , Síndrome Nefrótica/etiologia , Idoso , Diagnóstico Diferencial , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/metabolismo , Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Masculino , Síndrome Nefrótica/patologia , Espectrometria de Massas em Tandem
5.
Clin Exp Nephrol ; 24(5): 465-473, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31933049

RESUMO

BACKGROUND: Asymptomatic blood pressure (BP) elevation may be associated with cerebral hemorrhage (CH); however, few studies have investigated this association. We aimed to evaluate BP elevation before CH in hemodialysis (HD) patients and elucidate its associated factors. METHODS: We reviewed HD patients treated for CH at our hospital between 2008 and 2019 (CH group). The control group comprised HD patients treated at Nagasaki Renal Center between 2011 and 2012. Data were obtained from medical records and three consecutive HD charts, made immediately before CH. HD1 was the session closest to onset, followed by HD2 and HD3. Systolic and mean BP were evaluated at the beginning of HD, and factors associated with BP elevation were investigated. RESULTS: The CH and control groups included 105 and 339 patients, respectively. Systolic and mean BP at HD1 were significantly higher than those at baseline (HD2 + HD3) in the CH group by 5 and 3 mmHg, respectively (P < 0.001). Multiple linear regression analysis showed that lower calcium levels were significantly associated with BP elevation in the CH group (P < 0.05). The CH group was sub-divided by June 2013; the latter group had lower calcium levels (9.2 mg/dL) and a marked systolic BP difference from baseline (+ 10 mmHg) compared with the former (9.5 mg/dL and - 4 mmHg). CONCLUSION: Asymptomatic BP elevation was observed in HD patients before CH; this elevation was associated with lower serum calcium levels and observed more frequently in the recent era. The precise mechanism underlying this effect remains unknown.


Assuntos
Pressão Sanguínea , Cálcio/sangue , Hemorragia Cerebral/etiologia , Hipocalcemia/fisiopatologia , Diálise Renal/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sístole
7.
PLoS One ; 14(10): e0224111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31639169

RESUMO

The effect of statin on hemodialysis patients is controversial. Although previous large-scale studies did not clarify its effect in this population, recent studies suggest that statins could be useful in reducing the risk of cardiovascular events and all-cause mortality in specific groups of patients undergoing hemodialysis. The aforementioned large-scale studies included a small percentage of Asians, and few studies have investigated the effects of statins in Asians undergoing hemodialysis. Thus, we investigated the benefits of statins in patients undergoing maintenance hemodialysis at a single center in Japan. We obtained demographic, clinical, and hemodialysis data of all patients who underwent maintenance hemodialysis at the Nagasaki Renal Center between July 2011 and June 2012. Patients were followed-up until June 2018. We studied 339 patients, of which 51 (15.0%) were prescribed pitavastatin. The mean observation period was 4.1±2.3 years, 43% were women, and the median hemodialysis vintage at baseline was 4.7 years. During the follow-up, 198 patients (58%) died, of which 22 (43%) were prescribed pitavastatin and 176 (61%) were not prescribed any statins. After propensity score matching based on age, sex, dialysis vintage, dialysis time, diabetes mellitus, ischemic heart disease, dry weight, left ventricular ejection fraction, and serum albumin, an intergroup comparison between those who received statins and those who did not (44 patients in each group) showed significant differences in survival rate based on the log-rank test (P<0.05). Although the causes of death did not differ significantly between groups, deaths due to cardiovascular events, infections, and cancer were fewer in the group prescribed statins. Our results suggest that statins may reduce mortality in Japanese patients undergoing maintenance hemodialysis. Although potential residual confounders exist, statins may have an influence on the reduction in the incidence of cardiovascular events, infections, and cancer. Nevertheless, further studies are required to prove this hypothesis.


Assuntos
Insuficiência Cardíaca/mortalidade , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Falência Renal Crônica/terapia , Neoplasias/mortalidade , Diálise Renal/efeitos adversos , Idoso , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Masculino , Neoplasias/etiologia , Neoplasias/prevenção & controle , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
8.
BMC Nephrol ; 20(1): 210, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174486

RESUMO

BACKGROUND: High serum calcium levels should be avoided in patients on hemodialysis (HD) because they can induce cardiovascular diseases and worsen the patient's prognosis. In contrast, low serum calcium levels worsen the prognosis of patients with cerebral hemorrhage in the general population. So far, whether serum calcium levels in patients on HD are associated with cerebral hemorrhage remains unknown. This study aimed to reveal the association between serum calcium and cerebral hemorrhage in patients on HD, including in-hospital death, volume of hematoma, and onset of cerebral hemorrhage. METHODS: This cross-sectional case-control study included 99 patients on HD with cerebral hemorrhage at a single center between July 1, 2007 and December 31, 2017. Controls included 339 patients on HD at a single HD center between July 1, 2011 and June 30, 2012. Data on serum calcium level, patient demographics, and comorbid conditions were collected, and associations between cerebral hemorrhage and subsequent death were evaluated by multivariate logistic regression analysis. Further, the association of these backgrounds and hematoma volume was evaluated by multiple regression analysis. RESULTS: Of the 99 patients, 32 (32%) died from cerebral hemorrhage. The corrected serum calcium level (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.43-4.35; P < 0.001) and antiplatelet drug use (OR, 3.95; 95% CI, 1.50-10.4; P = 0.005) had significant effects on the prognosis. Moreover, the corrected serum calcium (P = 0.003) and antiplatelet drug use (P = 0.01) were significantly correlated with hematoma volume. In the patients, the corrected serum calcium level (OR, 1.54; 95% CI, 1.07-2.22; P = 0.02) was associated with the onset of cerebral hemorrhage, as was pre-hemodialysis systolic blood pressure (per 10 mmHg) (OR, 1.40; 95% CI, 1.23-1.59; P < 0.001). CONCLUSIONS: Although the precise mechanisms remain unknown, a high serum calcium level is associated with cerebral hemorrhage in patients on HD. Thus, we should pay attentions to a patient's calcium level.


Assuntos
Cálcio/sangue , Hemorragia Cerebral , Falência Renal Crônica , Diálise Renal , Estudos de Casos e Controles , Hemorragia Cerebral/sangue , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Diálise Renal/efeitos adversos , Diálise Renal/métodos
9.
Intern Med ; 58(1): 91-96, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30146584

RESUMO

A 44-year-old man who received allogenic hematopoietic stem cell transplantation after being diagnosed with acute myeloid leukemia developed nephrosis when the dose of tacrolimus was tapered. A renal biopsy showed the granular deposition of immunoglobulin G in the glomerular basement membrane and subepithelial electron-dense deposits, crescent formation, C4d-positive staining of the peritubular capillary, and subendothelial swelling, suggesting that the main pathological diagnosis was membranous nephropathy and that chronic graft-versus-host disease played a role in the etiology of nephrosis. We herein report a case of membranous nephropathy with various pathological findings. C4d deposition suggests complement activation and the involvement of humoral factors.


Assuntos
Glomerulonefrite Membranosa/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adulto , Complemento C4b/metabolismo , Doença Enxerto-Hospedeiro/complicações , Humanos , Leucemia Mieloide Aguda/terapia , Masculino
10.
CEN Case Rep ; 6(2): 189-193, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28856578

RESUMO

In a case of 41-year-old man with mild nephropathy, Alport syndrome (AS) was diagnosed from the renal biopsy. However, the α5 chain of type IV collagen expressed in the glomerular basement membrane, which was the atypical staining pattern of AS. Genetic testing suggested autosomal recessive AS from heterozygous mutations at two positions in the type IV collagen α3 chain. These two gene mutations represented a new pattern of mutation and was suggested the association with an atypical α5 chain expression and mild phenotype.

11.
Drugs R D ; 17(3): 389-396, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28547536

RESUMO

BACKGROUND AND OBJECTIVE: We compared the hemoglobin-maintaining effects between continuous erythropoietin receptor activator (CERA) and darbepoetin-α (DA) in patients with chronic kidney disease (CKD) during the 3 months before dialysis initiation. METHODS: This study was conducted with 37 CERA-administered patients and 26 DA-administered patients who had initiated dialysis at a participating facility between January 2012 and December 2014. We investigated clinical laboratory data 3 months before and at dialysis initiation, and compared these data between the CERA and DA groups. RESULTS: No significant differences in hemoglobin level or reticulocyte count were found between the two groups 3 months before dialysis initiation. However, at dialysis initiation, the hemoglobin level (CERA 9.82 ± 1.52 vs. DA 8.79 ± 1.07 g/dL; P = 0.003) and the reticulocyte count (CERA 5.21 ± 2.95 vs. DA 3.15 ± 1.62 × 104/µL; P = 0.004) were significantly higher in the CERA group than in the DA group. Moreover, the extent of changes in the erythropoietin resistance index during the 3 months before dialysis initiation was significantly increased in the DA group compared with the CERA group. CONCLUSIONS: Our results suggest that CERA may be more effective than DA in maintaining hemoglobin levels in patients with CKD during 3 months before dialysis initiation.


Assuntos
Darbepoetina alfa/uso terapêutico , Eritropoetina/uso terapêutico , Hematínicos/uso terapêutico , Polietilenoglicóis/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/fisiopatologia , Contagem de Reticulócitos , Fatores de Tempo
12.
Med Sci Monit ; 23: 1464-1470, 2017 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-28343234

RESUMO

BACKGROUND Endocan is expressed in vascular endothelial cells, and its expression is enhanced following endothelial injury via inflammatory cytokines. Subsequently, endocan is secreted into the circulation. Thus, serum endocan levels are considered a marker of endothelial injury. However, to the best of our knowledge, no data on the serum endocan levels in peritoneal dialysis (PD) patients are available. MATERIAL AND METHODS This study included 21 PD patients who underwent peritoneal equilibration test (PET) more than once between 2011 and 2015. Serum samples were collected from each patient, and the 24-h urine volume was measured at the time of PET. Serum endocan levels were measured using enzyme-linked immunosorbent assay (ELISA) at the time of the first PET, and their relationship with clinical data or the extent of urine volume decline (mL/year) was analyzed retrospectively. RESULTS Serum endocan levels were positively correlated with proteinuria level, serum creatinine level, serum tumor necrosis factor (TNF)-α level, ß2-microglobulin level, and PD drainage volume, but not with urine volume at baseline. The extent of decline in urine volume was significantly associated with serum endocan level, proteinuria level, serum creatinine level, and serum TNF-α level at baseline in a simple linear regression analysis. Moreover, multiple linear regression analysis showed that the serum endocan level and proteinuria level at baseline were independent predictors for the extent of decline in urine volume. CONCLUSIONS The results of this study indicate that serum endocan level and proteinuria level may be useful predictive markers for decreased urine volume in PD patients.


Assuntos
Rim/fisiopatologia , Proteínas de Neoplasias/sangue , Diálise Peritoneal/métodos , Proteinúria/urina , Proteoglicanas/sangue , Adulto , Idoso , Biomarcadores/sangue , Creatina/sangue , Células Endoteliais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/sangue , Micção/fisiologia
13.
Clin Exp Nephrol ; 20(1): 50-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26055039

RESUMO

BACKGROUND: In addition to corticosteroids and inhibition of the renin-angiotensin-aldosterone system, tonsillectomy with steroid pulse therapy (TSP) may have a beneficial impact on the clinical course of IgA nephropathy (IgAN). However, there is still much uncertainty regarding the indications for therapy, treatment protocol, and therapeutic options for IgAN. METHODS: In this multicenter retrospective cohort study, we enrolled 284 patients with biopsy-proven IgAN who received TSP or corticosteroid therapy or conservative therapy. The effects of TSP on clinical remission (CR) were evaluated after a median follow-up period of 4.1 years in relation to histological classifications. RESULTS: Among the 284 participants, 161 patients received TSP. During the observation time, 141 patients (49.6%) achieved CR, with a median time to remission of 397 days. In multivariate Cox regression analyses, TSP had an impact on achieving CR in only the group with histological grade 3 defined as glomerulosclerosis, crescent formation or adhesion to Bowman's capsule in 10-30% of all biopsied glomeruli, or mild cellular infiltration in the interstitium (hazard ratio (HR) 4.29, 95% confidence interval (95%CI) 1.88-11.19, P < 0.001). TSP independently contributed to a higher incidence of CR, particularly in the patient group showing evident mesangial hypercellularity (HR 2.54, 95%CI 1.38-5.08, P = 0.002). CONCLUSIONS: TSP may have a beneficial effect on the clinical course in IgAN patients with mild to moderate glomerular and interstitial lesions, particularly with distinct mesangial cell proliferation.


Assuntos
Glomerulonefrite por IGA/terapia , Glomérulos Renais/efeitos dos fármacos , Esteroides/administração & dosagem , Tonsilectomia , Adulto , Biópsia , Distribuição de Qui-Quadrado , Terapia Combinada , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/imunologia , Humanos , Japão , Estimativa de Kaplan-Meier , Glomérulos Renais/imunologia , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Pulsoterapia , Indução de Remissão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Intern Med ; 53(7): 767-70, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24694494

RESUMO

A 38-year-old man underwent peritoneal dialysis (PD) in May 2011 due to chronic renal failure with chronic glomerulonephritis. In early February 2012, he underwent laparoscopy to salvage and correct a malpositioned PD catheter. The laparoscopic intra-abdominal findings revealed turbid ascites and multiple fibrin lumps, despite the patient's lack of history of peritonitis. Based on these findings, in addition to the presence of continuous inflammation and ascites, a diagnosis of pre-encapsulating peritoneal sclerosis was suspected, and the treatment was switched from PD to hemodialysis. The administration of prednisolone at a dose of 20 mg/day and peritoneal lavage resulted in a decrease in the ascites and fibrin lumps.


Assuntos
Ascite/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Adulto , Ascite/diagnóstico , Diagnóstico Diferencial , Seguimentos , Humanos , Laparoscopia , Masculino , Peritonite/diagnóstico , Fatores de Tempo
15.
Clin Drug Investig ; 33(11): 837-46, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24068630

RESUMO

BACKGROUND: Muscle wasting is common and insidious in end-stage renal disease (ESRD). Loss of muscle quantity and quality reduces quality of life and increases mortality in ESRD patients. Additionally, secondary hyperparathyroidism (SHPT) causes muscle atrophy. Meanwhile, vitamin D, which is used for SHPT treatment, plays an essential role in muscle growth. OBJECTIVES: We prospectively investigated the effect of active vitamin D administration on muscle mass. METHODS: We measured muscle mass based on bioelectrical impedance analysis in 68 hemodialysis patients. Patients were divided into a control group (without active vitamin D administration) and a VitD group (with active vitamin D administration). We compared muscle mass at the beginning of treatment and 1 year later. We also investigated health-related quality of life (HR-QOL) using the Medical Outcome Study Short Form-36 (SF-36). RESULTS: The VitD group experienced a significant increase in the amount of change in total muscle mass and muscle mass percentage in men (p = 0.025) but not in women (p = 0.945). By multivariable logistic regression analysis, active vitamin D administration was independently associated with increased muscle mass percentage in men only. In the SF-36, the physical functioning (PF) scores were significantly decreased at the end of the study in the patients without active vitamin D treatment, especially in women. CONCLUSION: Our results suggested that active vitamin D treatment was associated with increased muscle mass in men, and it might have a favorable effect on maintaining PF in HR-QOL in hemodialysis patients.


Assuntos
Falência Renal Crônica/terapia , Músculo Esquelético/efeitos dos fármacos , Diálise Renal , Vitamina D/farmacologia , Adulto , Idoso , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Vitamina D/administração & dosagem
16.
Biol Pharm Bull ; 36(8): 1271-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23902971

RESUMO

Stroke-prone spontaneously hypertensive (SHRsp) rats develop severe hypertension resulting in renal injury. We investigated apoptosis inhibitor of macrophages (AIM) expression in nephrosclerotic rats and the involvement of AIM in olmesartan (OLM)- and azelnidipine (AZN)-induced decreases in the number of macrophages infiltrating the kidney. We randomly assigned 20-week-old male SHRsp rats to receive one of the following substances every day for 12 weeks: water (vehicle), hydralazine (HYD), OLM, or AZN. Renal damage was assessed by Masson trichrome staining. Expressions of ED-1, AIM, and oxidized low-density lipoprotein (oxLDL) were immunohistochemically detected. Apoptosis was analyzed by terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL) staining. All treatment groups showed significantly less renal interstitial fibrosis than the vehicle group. AZN and OLM groups had significantly fewer AIM-expressing cells than the HYD and vehicle groups. The ratios AIM-positive cells/ED-1-positive macrophages and TUNEL-positive cells/ED-1-positive macrophages in the AZN and OLM groups were lower and higher, respectively, than the the HYD and vehicle groups. oxLDL expression in the renal interstitium was significantly lower in treatment groups compared to vehicle group. OLM and AZN inhibited interstitial fibrosis progression in SHRsp rats by suppressing AIM expression in macrophages, followed by reducing the number of infiltrating macrophages.


Assuntos
Anti-Hipertensivos/farmacologia , Ácido Azetidinocarboxílico/análogos & derivados , Bloqueadores dos Canais de Cálcio/farmacologia , Di-Hidropiridinas/farmacologia , Hipertensão/metabolismo , Imidazóis/farmacologia , Nefroesclerose/metabolismo , Receptores Depuradores/metabolismo , Tetrazóis/farmacologia , Animais , Anti-Hipertensivos/uso terapêutico , Ácido Azetidinocarboxílico/farmacologia , Ácido Azetidinocarboxílico/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Quimiocina CCL2/metabolismo , Di-Hidropiridinas/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Imidazóis/uso terapêutico , Proteínas Inibidoras de Apoptose/metabolismo , Rim/metabolismo , Rim/patologia , Lipoproteínas LDL/metabolismo , Macrófagos/metabolismo , Masculino , Nefroesclerose/tratamento farmacológico , Nefroesclerose/patologia , Olmesartana Medoxomila , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Tetrazóis/uso terapêutico
17.
Intern Med ; 52(1): 135-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23291689

RESUMO

A 76-year-old woman on hemodialysis (HD) presented with pain and swelling in the left wrist and forearm. The osteomyelitis occurred in the part of the ulna adjacent to the arteriovenous fistula. Mycobacterium tuberculosis was identified in pus obtained from the left forearm, leading to a diagnosis of tuberculous osteomyelitis. The patient was treated with anti-tuberculous drugs and her symptoms improved. In this study, we report a case of tuberculous osteomyelitis occurring in the ulna, which is not the usual site of predilection for tuberculosis infection. As HD patients exhibit a high frequency of extrapulmonary tuberculosis, tuberculous osteomyelitis should be considered in the differential diagnosis of infectious osteomyelitis. In addition, it may be useful to perform stab cultures at an early stage in order to diagnose tuberculous osteomyelitis.


Assuntos
Antituberculosos/uso terapêutico , Osteomielite/microbiologia , Diálise Renal/métodos , Tuberculose Osteoarticular/diagnóstico , Ulna/cirurgia , Idoso , Terapia Combinada/métodos , Curetagem/métodos , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Seguimentos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Mycobacterium tuberculosis/isolamento & purificação , Osteomielite/diagnóstico , Osteomielite/terapia , Radiografia , Medição de Risco , Resultado do Tratamento , Tuberculose Osteoarticular/terapia , Ulna/diagnóstico por imagem
18.
Clin Transplant ; 26 Suppl 24: 81-5, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22747482

RESUMO

We report the clinical and pathological findings of a case of de novo minimal change disease (MCD) after ABO-incompatible living kidney transplantation. A 62-yr-old man with end-stage renal disease associated with type I diabetes received ABO-incompatible kidney transplantation from his 58-yr-old wife. Although allograft function was excellent immediately after surgery, massive proteinuria (35 g/d) appeared on post-transplantation day 5. After the allograft biopsy taken on post-transplantation day 6, he was treated with 12 cycles of plasma exchange, but the nephrotic-range proteinuria showed no remission. The biopsy specimen showed no significant pathological findings on light microscopy, but electron microscopy showed diffuse effacement of podocyte foot processes. Based on the diagnosis of de novo MCD, the patient received intravenous methylprednisolone pulse therapy, followed by high-dose steroid maintenance therapy. The steroid therapy induced complete remission of nephrotic syndrome and stable allograft function immediately, which was also maintained at one yr after the transplantation.


Assuntos
Sistema ABO de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos/imunologia , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Transplante de Rim/imunologia , Nefrose Lipoide/etiologia , Síndrome Nefrótica/etiologia , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/tratamento farmacológico , Nefrose Lipoide/patologia , Síndrome Nefrótica/tratamento farmacológico , Síndrome Nefrótica/patologia , Proteinúria/tratamento farmacológico , Proteinúria/etiologia , Proteinúria/patologia
19.
Intern Med ; 51(13): 1715-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22790132

RESUMO

The patient, a 77-year-old-man, began peritoneal dialysis (PD) in August 2005. In January 2009, he developed lower abdominal pain and cloudy PD effluent. A diagnosis of peritonitis was made and Escherichia coli was detected in cultures of the PD effluent. An abdominal computed tomography scan showed a fish bone in the duodenal wall. An upper gastrointestinal endoscopy was performed, and a 3-cm fish bone was removed. We thus recommend careful investigation with the possibility of enteric peritonitis from the intestinal tract when E. coli is detected in effluent cultures during PD.


Assuntos
Duodeno/lesões , Infecções por Escherichia coli/etiologia , Perfuração Intestinal/etiologia , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Idoso , Animais , Osso e Ossos , Soluções para Diálise , Infecções por Escherichia coli/diagnóstico , Peixes , Corpos Estranhos/diagnóstico , Humanos , Perfuração Intestinal/diagnóstico , Masculino , Peritonite/diagnóstico , Peritonite/microbiologia
20.
Intern Med ; 51(10): 1227-32, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22687795

RESUMO

A 67-year-old man, on oral therapy for type 2 diabetes mellitus since 1990, had sustained proteinuria since 2005. When hematuria was first discovered in 2008, renal dysfunction [creatinine (Cr), 1.2 mg/dL], inflammation [C-reactive protein (CRP), 12 mg/dL] and high myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) levels [546 ELISA units (EU)] were observed. Renal biopsy showed the diagnosis of ANCA-associated nephritis combined with diabetic nephropathy. For this patient, there was pathological proof of the combination of diabetic nephropathy and ANCA-associated vasculitis.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/metabolismo , Nefropatias Diabéticas/complicações , Glomerulonefrite/complicações , Glomerulonefrite/imunologia , Idoso , Nefropatias Diabéticas/patologia , Glomerulonefrite/patologia , Humanos , Masculino
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