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1.
PLoS One ; 15(2): e0228259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32032397

RESUMO

AIMS AND OBJECTIVES: To classify hemodialysis patients into subgroups via cluster analysis according to the Somatic Symptoms Disturbance Index, Taiwanese Depression Scale, and Herth Hope Index scores. Patient demands in each cluster were also examined. BACKGROUND: Overall patient demands among hemodialysis patients have been demonstrated in numerous reports; however, variables among subgroups have not been explored. METHODS: Data were analyzed from a cross-sectional survey of 114 hemodialysis patients recruited from dialysis centers in Northern Taiwan. Hope, depression, and symptom disturbance were used as parameters for clustering because they have been shown to be important factors affecting patient demands. A two-step cluster analysis was performed to classify participants into clusters. Patient demands in each cluster were analyzed. RESULTS: Among the 114 participants, there was a negative correlation between hope and depression as well as between hope and symptom disturbance; there was a positive correlation between depression and symptom disturbance. Two clusters were identified: Cluster 1 (n = 49) included patients with moderate levels of hope and symptom disturbance, and high levels of depression; and Cluster 2 (n = 65) included patients with low levels of depression and symptom disturbance and high levels of hope. Demographic profiles differed between the two clusters. Regarding patient demands, medical demand showed the highest average score; whereas, occupational demand exhibited the lowest average score. Psychological and occupational demands differed significantly between the two clusters. The two clusters were defined as subgroups: Cluster 1 was labeled "resting"; Cluster 2 was labeled "active". CONCLUSIONS: Cluster analysis may further classify hemodialysis patients into distinct subgroups base on their specific patient demands. A better understanding of patient demands may help health professionals to provide a holistic individualized treatment to improve patients' outcomes.


Assuntos
Falência Renal Crônica/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Estudos Transversais , Depressão/patologia , Feminino , Esperança , Humanos , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Taiwan , Adulto Jovem
2.
Ann Lab Med ; 40(1): 48-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432639

RESUMO

BACKGROUND: Anti-carbohydrate antibody responses, including those of anti-blood group ABO antibodies, are yet to be thoroughly studied in humans. Because anti-ABO antibody-mediated rejection is a key hurdle in ABO-incompatible transplantation, it is important to understand the cellular mechanism of anti-ABO responses. We aimed to identify the main human B cell subsets that produce anti-ABO antibodies by analyzing the correlation between B cell subsets and anti-ABO antibody titers. METHODS: Blood group A-binding B cells were analyzed in peritoneal fluid and peripheral blood samples from 43 patients undergoing peritoneal dialysis and 18 healthy volunteers with blood group B or O. The correlation between each blood group A-specific B cell subset and anti-A antibody titer was then analyzed using Pearson's correlation analysis. RESULTS: Blood group A-binding B cells were enriched in CD27+CD43+CD1c- B1, CD5+ B1, CD11b+ B1, and CD27+CD43+CD1c+ marginal zone-B1 cells in peripheral blood. Blood group A-specific B1 cells (P=0.029 and R=0.356 for IgM; P=0.049 and R=0.325 for IgG) and marginal zone-B1 cells (P=0.011 and R=0.410 for IgM) were positively correlated with anti-A antibody titer. Further analysis of peritoneal B cells confirmed B1 cell enrichment in the peritoneal cavity but showed no difference in blood group A-specific B1 cell enrichment between the peritoneal cavity and peripheral blood. CONCLUSIONS: Human B1 cells are the key blood group A-specific B cells that have a moderate correlation with anti-A antibody titer and therefore constitute a potential therapeutic target for successful ABO-incompatible transplantation.


Assuntos
Anticorpos/sangue , Linfócitos B/metabolismo , Sistema ABO de Grupos Sanguíneos/imunologia , Adulto , Antígenos CD1/metabolismo , Subpopulações de Linfócitos B/citologia , Subpopulações de Linfócitos B/metabolismo , Linfócitos B/citologia , Feminino , Glicoproteínas/metabolismo , Humanos , Falência Renal Crônica/imunologia , Falência Renal Crônica/patologia , Leucossialina/metabolismo , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal , Estudos Prospectivos
3.
Zhonghua Bing Li Xue Za Zhi ; 48(11): 846-850, 2019 Nov 08.
Artigo em Chinês | MEDLINE | ID: mdl-31775432

RESUMO

Objective: To investigate the clinicopathological characteristics and prognosis of renal cell carcinoma (RCC) in patients with end-stage renal disease (ESRD). Methods: The clinicopathological data of patients of renal cell carcinoma arising in end-stage renal disease were collected from the Affiliated Hospital of Qingdao University (ten cases) and 971 Hospital of PLA Navy (five cases) from January 2009 to August 2018. Results: Among 15 patients, 14 were male and 1 was female, and the age ranged from 38 to 78 years (mean 51 years, median 49 years). All patients had history of chronic renal failure (7-192 months), including 9 patients treated with hemodialysis for 6 to 132 months. In 12 cases the tumor border was distinct and the tumor size ranged from 1.8 to 11.0 cm. Two cases were multifocal and one case showed extensive renal hemorrhage with an inconspicuous tumor mass. Microscopically, 9 cases were clear cell reanl cell carcinoma including one with sarcomatoid differentiation, 4 were acquired cystic kidney disease-associated(ACKD-RCC) and two were papillary renal cell carcinoma. All patients had a follow-up of 3 to 120 months. Four patients died during a follow-up of 6 to 60 months (mean 30 months) as a result of extensive distant metastases (two cases) and renal failure (two cases), while other eleven patients were alive without tumor recurrence or metastasis (median 40.8 months of follow-up ranging from 3 to 120 months). Conclusions: ESRD-RCC is more often seen in younger male patients. The time intervals from the onset of chronic renal failure to the diagnosis of renal cell carcinoma differ and tumors are frequently incidental findings. The histological types can be sporadic renal cell carcinoma or unique ACKD-RCC. Tumors are often hemorrhagic and necrotic. Routine physical examination and early detection could benefit ESRD-RCC patients. ESRD-RCC may have a favorable prognosis despite of a large tumor size or the presence of sarcomatoid differentiation.


Assuntos
Carcinoma de Células Renais/patologia , Falência Renal Crônica/patologia , Neoplasias Renais/patologia , Adulto , Idoso , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefrectomia , Prognóstico
5.
Ren Fail ; 41(1): 914-920, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31580172

RESUMO

Purpose: To investigate the potential association between lifestyles, including cigarette smoking, alcohol consumption, and physical exercise at the time of biopsy and the risk for developing end-stage renal failure (ESRF) among IgA nephropathy (IgAN) patients within 10 years. Methods: A case-control study was carried out. Seventy-seven ESRF patients with the primary cause of IgAN were enrolled as cases. Seventy-seven IgAN patients who had not progressed to ESRF after being diagnosed for over 10 years served as controls. Smoking, alcohol consumption and physical exercise related data and baseline clinical features were collected from their medical records and confirmed by phone calls. Results: The case group had higher proportions of males, smokers, drinkers, and physical inactivity individuals than the controls had. Alcohol drinking history (/1 year, OR 1.32, p < .05) is independently associated with an increased risk of ESRF, while physical exercise habits (OR 0.06, p < .05) associated with a decreased risk of ESRF in multivariate logistic analysis. Male gender, lower eGFR, and higher urinary protein at the time of biopsy were also independent risk factors. Moreover, male-non-exercise population seems to be more likely to progress to ESRF than others (male-exercise, female-exercise, and female-none-exercise populations). Conclusion: Physical exercise should be encouraged in IgAN patients, especially in males, for a better renal outcome. Alcohol cessation might have a renal survival benefit in IgAN patients.


Assuntos
Exercício Físico/fisiologia , Glomerulonefrite por IGA/complicações , Falência Renal Crônica/epidemiologia , Estilo de Vida , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Biópsia , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/patologia , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
6.
Ren Fail ; 41(1): 832-841, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509055

RESUMO

Introduction: Autosomal dominant tubulointerstitial kidney disease (ADTKD) is a rare genetic cause of renal impairment resulting from mutations in the MUC1, UMOD, HNF1B, REN, and SEC61A1 genes. Neither the national or global prevalence of these diseases has been determined. We aimed to establish a database of patients with ADTKD in Ireland and report the clinical and genetic characteristics of these families. Methods: We identified patients via the Irish Kidney Gene Project and referral to the national renal genetics clinic in Beaumont Hospital who met the clinical criteria for ADTKD (chronic kidney disease, bland urinary sediment, and autosomal dominant inheritance). Eligible patients were then invited to undergo genetic testing by a variety of methods including panel-based testing, whole exome sequencing and, in five families who met the criteria for diagnosis of ADTKD but were negative for causal genetic mutations, we analyzed urinary cell smears for the presence of MUC1fs protein. Results: We studied 54 individuals from 16 families. We identified mutations in the MUC1 gene in three families, UMOD in five families, HNF1beta in two families, and the presence of abnormal MUC1 protein in urine smears in three families (one of which was previously known to carry the genetic mutation). We were unable to identify a mutation in 4 families (3 of whom also tested negative for urinary MUC1fs). Conclusions: There are 4443 people with ESRD in Ireland, 24 of whom are members of the cohort described herein. We observe that ADTKD represents at least 0.54% of Irish ESRD patients.


Assuntos
Genes Dominantes , Falência Renal Crônica/genética , Túbulos Renais/patologia , Adulto , Idoso , Estudos Transversais , Feminino , Testes Genéticos/estatística & dados numéricos , Fator 1-beta Nuclear de Hepatócito/genética , Humanos , Irlanda/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Mucina-1/genética , Mutação , Prevalência , Uromodulina/genética
7.
BMJ Case Rep ; 12(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31537605

RESUMO

A 26-year-old Caucasian man with no medical history, except years of oral and intravenous drug abuse, presented with fatigue, shortness of breath, epistaxis and uncontrolled hypertension. He was pale with skin ecchymosis over his thighs and was anaemic, with severe renal failure and metabolic acidosis. Following initial clinical stabilisation of the patient, a renal biopsy was obtained, which showed vascular and glomerular changes consistent with thrombotic microangiopathic injury and advanced glomerulosclerosis. He was treated with antihypertensives and required haemodialysis. He admitted using 'crystal meth' regularly for many years, which is likely responsible for his renal failure. We present the case to illustrate methamphetamine-induced renal disease leading to end-stage renal disease and to bring awareness among practising clinicians, ancillary healthcare workers and public health professionals of this often undervalued cause of renal failure, which can be prevented.


Assuntos
Falência Renal Crônica/induzido quimicamente , Falência Renal Crônica/patologia , Metanfetamina/efeitos adversos , Acidose/complicações , Adulto , Progressão da Doença , Humanos , Hipertensão/complicações , Masculino , Abuso de Substâncias por Via Intravenosa , Abuso Oral de Substâncias
8.
Sensors (Basel) ; 19(15)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31382707

RESUMO

The classifier of support vector machine (SVM) learning for assessing the quality of arteriovenous fistulae (AVFs) in hemodialysis (HD) patients using a new photoplethysmography (PPG) sensor device is presented in this work. In clinical practice, there are two important indices for assessing the quality of AVF: the blood flow volume (BFV) and the degree of stenosis (DOS). In hospitals, the BFV and DOS of AVFs are nowadays assessed using an ultrasound Doppler machine, which is bulky, expensive, hard to use, and time consuming. In this study, a newly-developed PPG sensor device was utilized to provide patients and doctors with an inexpensive and small-sized solution for ubiquitous AVF assessment. The readout in this sensor was custom-designed to increase the signal-to-noise ratio (SNR) and reduce the environment interference via maximizing successfully the full dynamic range of measured PPG entering an analog-digital converter (ADC) and effective filtering techniques. With quality PPG measurements obtained, machine learning classifiers including SVM were adopted to assess AVF quality, where the input features are determined based on optical Beer-Lambert's law and hemodynamic model, to ensure all the necessary features are considered. Finally, the clinical experiment results showed that the proposed PPG sensor device successfully achieved an accuracy of 87.84% based on SVM analysis in assessing DOS at AVF, while an accuracy of 88.61% was achieved for assessing BFV at AVF.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Falência Renal Crônica/patologia , Aprendizado de Máquina , Fotopletismografia/métodos , Fluxo Sanguíneo Regional/fisiologia , Fístula Arteriovenosa/classificação , Constrição Patológica/classificação , Constrição Patológica/patologia , Hemodinâmica , Humanos , Falência Renal Crônica/complicações , Fotopletismografia/instrumentação , Razão Sinal-Ruído
9.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(2): 180-185, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31309756

RESUMO

OBJECTIVE: To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD). METHODS: A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. RESULTS: During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95-<120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (HR=1.40,95%CI:1.01-1.93,P<0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (HR=2.12,95%CI:1.32-3.40, P<0.01) and cardiovascular morality (HR=2.55, 95%CI:1.38-4.70, P<0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality. CONCLUSIONS: Both high MAP and low MAP are associated with higher risk of mortality in PD patients.


Assuntos
Pressão Arterial , Falência Renal Crônica , Diálise Peritoneal , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/patologia , Diálise Renal , Fatores de Risco
10.
Mol Med Rep ; 20(3): 2396-2402, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31322227

RESUMO

Long­term peritoneal dialysis is often limited or interrupted due to the development and progression of peritoneal fibrosis. Accumulating evidence suggests that epithelial­mesenchymal transition (EMT) is a major component of peritoneal injury associated with peritoneal fibrosis in the end stage of renal disease; however, at present, the underlying mechanisms remain unclear. Thus, in the present study, uric acid (UA)­induced EMT of peritoneal mesothelial cells was investigated by western­blot and immunofluorescence staining. The results revealed that peritoneal mesothelial cells stimulated with UA underwent EMT, as demonstrated by the decreased expression of epithelial markers (E­cadherin) and an increased expression of mesenchymal markers (α­smooth muscle actin and vimentin). Additionally, it was reported that UA could facilitate the progression of EMT of peritoneal mesothelial cells via EMT transcription pathways, including transforming growth factor­ß1/mothers against decapentaplegic homolog 3 and P38/mitogen­activated protein kinase by western­blot and reverse transcription semi­quantitative polymerase chain reaction. The results of the present study suggest that UA could promote EMT and may contribute to peritoneal chronic disease. Furthermore, the data obtained suggest that the levels of blood UA may account for the development of EMT; thus, lowering the levels of blood UA may be beneficial to inhibit the occurrence and development of peritoneal fibrosis.


Assuntos
Transição Epitelial-Mesenquimal , Epitélio/patologia , Fibrose Peritoneal/etiologia , Peritônio/patologia , Ácido Úrico/metabolismo , Linhagem Celular , Sobrevivência Celular , Epitélio/metabolismo , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/metabolismo , Falência Renal Crônica/patologia , Fibrose Peritoneal/metabolismo , Fibrose Peritoneal/patologia , Peritônio/metabolismo , Transdução de Sinais , Proteína Smad3/metabolismo , Fator de Crescimento Transformador beta1/metabolismo
11.
Biochimie ; 165: 100-107, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31325480

RESUMO

High glucose (HG)-induced podocyte injury contributes to the pathogenesis of diabetic nephropathy, a severe complication of diabetes. Bromodomain-containing protein 4 (BRD4) has emerged as a critical regulator for cell injury. However, whether BRD4 participates in HG-induced podocyte injury remains unclear. In this study, we aimed to explore the potential role of BRD4 in regulating HG-induced podocyte injury and its underlying molecular mechanism. HG exposure significantly upregulated BRD4 in podocytes. BRD4 inhibition by small interfering RNA or its chemical inhibitor (JQ1) markedly repressed HG-induced apoptosis and reactive oxygen species (ROS) production. By contrast, BRD4 overexpression exacerbated HG-induced podocyte injury. Moreover, BRD4 inhibition potentiated nuclear factor (erythroid-derived 2)-like 2 (Nrf2) signaling associated with suppression of Kelch-like ECH-associated protein (Keap1). BRD4 inhibition promoted Nrf2 nuclear translocation and upregulated the transcriptional activity of Nrf2/antioxidant response element (ARE). However, Nrf2 silencing partially reversed BRD4-inhibition-mediated protection against HG-induced podocyte injury. Overall, these results suggest that BRD4 inhibition confers cytoprotection against HG injury in podocytes through potentiation of Nrf2/ARE antioxidant signaling. This finding implicates BRD4/Nrf2/ARE signaling in the pathogenesis of diabetic nephropathy.


Assuntos
Nefropatias Diabéticas/metabolismo , Falência Renal Crônica/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Proteínas Nucleares/fisiologia , Podócitos , Fatores de Transcrição/fisiologia , Animais , Elementos de Resposta Antioxidante , Linhagem Celular , Nefropatias Diabéticas/patologia , Falência Renal Crônica/patologia , Proteínas Nucleares/metabolismo , Podócitos/metabolismo , Podócitos/patologia , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais
12.
PLoS One ; 14(5): e0217787, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150504

RESUMO

BACKGROUND: Economic evaluations of advance care planning (ACP) in people with chronic kidney disease are scarce. However, past studies suggest ACP may reduce healthcare costs in other settings. We aimed to examine hospital costs and outcomes of a nurse-led ACP intervention compared with usual care in the last 12 months of life for older people with end-stage kidney disease managed with haemodialysis. METHODS: We simulated the natural history of decedents on dialysis, using hospital data, and modelled the effect of nurse-led ACP on end-of-life care. Outcomes were assessed in terms of patients' end-of-life treatment preferences being met or not, and costs included all hospital-based care. Model inputs were obtained from a prospective ACP cohort study among dialysis patients; renal registries and the published literature. Cost-effectiveness of ACP was assessed by calculating an incremental cost-effectiveness ratio (ICER), expressed in dollars per additional case of end-of-life preferences being met. Robustness of model results was tested through sensitivity analyses. RESULTS: The mean cost of ACP was AUD$519 per patient. The mean hospital costs of care in last 12 months of life were $100,579 for those who received ACP versus $87,282 for those who did not. The proportion of patients in the model who received end-of-life care according to their preferences was higher in the ACP group compared with usual care (68% vs. 24%). The incremental cost per additional case of end-of-life preferences being met was $28,421. The greatest influence on the cost-effectiveness of ACP was the probability of dying in hospital following dialysis withdrawal, and costs of acute care. CONCLUSION: Our model suggests nurse-led ACP leads to receipt of patient preferences for end-of-life care, but at an increased cost.


Assuntos
Análise Custo-Benefício , Tomada de Decisões , Falência Renal Crônica/epidemiologia , Planejamento Antecipado de Cuidados/economia , Idoso , Idoso de 80 Anos ou mais , Técnicas de Apoio para a Decisão , Feminino , Custos de Cuidados de Saúde , Custos Hospitalares , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Qualidade de Vida , Diálise Renal , Assistência Terminal/economia
13.
Biomed Res Int ; 2019: 9617087, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31218229

RESUMO

One of the greatest challenges facing the field of organ transplantation is the shortage of donor organs for transplantation. Renal transplantation increases quality of life and survival of patients suffering from end-stage renal disease. Although kidney transplantation has evolved greatly over the past few decades, a not insignificant amount of injury occurs to the kidney during recovery, preservation, and implantation and leads to the loss of function and loss of years of dialysis-free living for many patients. The use of kidneys from expanded criteria donors (ECD) and donation after circulatory determination of death (DCDD) has been adopted partly in response to the shortage of donor kidneys; however these kidneys are even more susceptible to ischemic injury. It has been shown that matrix metalloproteinases (MMPs) and reactive oxygen species (ROS) are involved in mechanisms of injury to the transplant kidney. There is also some evidence that inhibition of MMP activity and/or ROS production can protect the kidney from injury. We review possible pharmacological strategies for protection of kidney graft from injury during recovery, preservation, and implantation.


Assuntos
Temperatura Baixa , Falência Renal Crônica/cirurgia , Transplante de Rim , Rim , Preservação de Órgãos/efeitos adversos , Traumatismo por Reperfusão , Transplantes , Humanos , Rim/metabolismo , Rim/patologia , Falência Renal Crônica/metabolismo , Falência Renal Crônica/patologia , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/prevenção & controle , Transplantes/metabolismo , Transplantes/patologia
14.
Transpl Immunol ; 55: 101210, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31226423

RESUMO

Renal transplantation is an effective therapy with improved long-term outcomes compared with other therapies for end stage renal disease. Present methods for evaluating kidney allograft function, such as serum creatinine or allograft biopsy, are not sensitive and identify pathological changes only after any potential intervention would be effective. Thus, there is a necessity for biomarkers that would provide early prognostic information about kidney transplant outcomes. Circulating microvesicles represent an attractive source of biomarkers for different diseases including renal failure. We have studied the proteins of the circulating microvesicles from two populations of kidney transplant recipients (n = 20) with poor transplant outcomes (n = 10) or good transplant outcome (n = 10), according to their estimated glomerular filtration rate (eGFR). Microvesicles from age-matched healthy subjects (n = 10) were used as a control. Also, we performed a pilot study to assess the microvesicle protein in kidney transplant recipients before and six months after kidney transplant (n = 6), compared to healthy subjects. Proteomic analysis of microvesicles could discriminate between transplant recipients and healthy subjects, and between transplant patients based on eGFR. Our results shed light on the potential of blood microvesicles to provide a novel tool for the prediction of the outcome of kidney transplants.


Assuntos
Micropartículas Derivadas de Células/metabolismo , Sobrevivência de Enxerto , Falência Renal Crônica/sangue , Transplante de Rim , Rim/metabolismo , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/patologia , Rim/fisiopatologia , Falência Renal Crônica/patologia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Proteômica
15.
Ren Fail ; 41(1): 521-531, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216914

RESUMO

Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD. Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model. Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10-1.30; I2 = 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient = 0.270, SE = 0.112, p = .033). Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings. Conclusion: ESRD patients with diabetes may benefit more from HD than PD.


Assuntos
Nefropatias Diabéticas/terapia , Falência Renal Crônica/terapia , Diálise Peritoneal , Diálise Renal , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/patologia , Progressão da Doença , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/patologia , Resultado do Tratamento
16.
Kidney Blood Press Res ; 44(4): 479-495, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238319

RESUMO

BACKGROUND/AIMS: Skeletal muscle atrophy is one of the main manifestations of protein energy wasting. We hypothesized that urotensin II (UII) can lead to skeletal muscle atrophy through upregulating autophagy and affecting Irisin precursor fibronectin type III domain containing 5 (FNDC5) expressions. METHODS: Three animal models (the sham operation, wild-type C57BL/6 mice with 5/6 nephrectomy, UII receptor (UT) gene knockout (UTKO) mice with 5/6 nephrectomy) were designed. Skeletal muscle weight, cross-sectional area (CSA) along with UII, FNDC5, LC3, and p62 expression were investigated. C2C12 cells were differentiated for up to 4 days into myotubes. These cells were then exposed to different UII concentrations (10-5 to 10-7 M) for 6-12 h and analyzed for the expressions of autophagic markers. These cells were also exposed to the same predetermined UII concentrations for 48-72 h and analyzed for the FNDC5 expression. Myotube diameter was measured. RESULTS: Upregulation of UII expression in skeletal muscle tissue was accompanied by reduced muscle weight and skeletal muscle CSA in the 2 posterior limbs, upregulated autophagy markers expression, and downregulated FNDC5 expression in 5/6 nephrectomy mice. The decrease of skeletal muscle weight, skeletal muscle CSA, downregulation of FNDC5 expression, and the upregulation of autophagy markers were inhibited in UTKO with 5/6 nephrectomy mice. Our in vitrostudy showed that UII could directly decrease myotube diameter, induce autophagy markers upregulation, and inhibit expression of FNDC5. When UII receptor gene was interfered by UT-specific siRNA, UII induced autophagy markers upregulation and FNDC5 downregulation were inhibited. CONCLUSION: We are the first to verify UII induces mice skeletal muscle atrophy associated with enhanced skeletal muscle autophagy and inhibited FNDC5 expression in chronic renal failure.


Assuntos
Atrofia/induzido quimicamente , Autofagia/efeitos dos fármacos , Fibronectinas/antagonistas & inibidores , Falência Renal Crônica/metabolismo , Músculo Esquelético/patologia , Urotensinas/farmacologia , Animais , Linhagem Celular , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Domínio de Fibronectina Tipo III , Fibronectinas/metabolismo , Falência Renal Crônica/patologia , Camundongos
17.
Ren Fail ; 41(1): 363-369, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31057017

RESUMO

OBJECTIVES: This study aimed to investigate the unique prognostic, clinical, and renal histopathological characteristics of patients with idiopathic membranous nephropathy (IMN) with different levels of proteinuria. METHODS: This retrospective observational study included 190 IMN patients with low levels of proteinuria (low group), 193 IMN patients with medium levels of proteinuria (medium group), and 123 IMN patients with high levels of proteinuria (high group) treated between September 2006 and November 2015. Prognostic and baseline clinical and histopathological data were compared among the three groups. Poor prognostic events included the occurrence of a persistent 50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease, or all-cause mortality. RESULTS: The severity of clinical symptoms and laboratory indices, such as blood pressure; extent of edema and hematuria; levels of fibrinogen, immunoglobulin (Ig)-G, complement (C)-4, total protein, albumin (ALB), and serum creatinine (SCr); and eGFR increased with increasing proteinuria (all p< .001). Based on renal histopathology, the extent of segmental sclerosis and balloon adhesion and renal interstitial lesion stage also increased in severity with increasing proteinuria (all p< .001). The Kaplan-Meier analysis showed that compared with patients with low and medium levels of proteinuria, patients with high levels of proteinuria had significantly lower cumulative poor event-free renal survival rates (p= .0039). CONCLUSIONS: Baseline proteinuria level is indicative of prognosis in IMN patients; the greater the extent of proteinuria is, the worse the prognosis.


Assuntos
Glomerulonefrite Membranosa/mortalidade , Falência Renal Crônica/epidemiologia , Proteinúria/diagnóstico , Índice de Gravidade de Doença , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite Membranosa/patologia , Glomerulonefrite Membranosa/urina , Humanos , Estimativa de Kaplan-Meier , Rim/patologia , Falência Renal Crônica/patologia , Falência Renal Crônica/urina , Masculino , Pessoa de Meia-Idade , Prognóstico , Proteinúria/mortalidade , Proteinúria/patologia , Estudos Retrospectivos , Taxa de Sobrevida
18.
Biomed Res Int ; 2019: 2979142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31058186

RESUMO

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.


Assuntos
Carcinoma/epidemiologia , Falência Renal Crônica/epidemiologia , Transplante de Rim/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Idoso , Carcinoma/etiologia , Carcinoma/patologia , Carcinoma/cirurgia , Feminino , Humanos , Imunossupressão , Estimativa de Kaplan-Meier , Falência Renal Crônica/etiologia , Falência Renal Crônica/patologia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Nefroureterectomia , Fatores de Risco , Taiwan/epidemiologia , Sistema Urinário/patologia , Urotélio/patologia
19.
Rom J Intern Med ; 57(3): 254-261, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31075086

RESUMO

INTRODUCTION: More than 50% of glomerular crescent formation is required for a diagnosis of crescentic glomerulonephritis in a kidney biopsy. Although treatment protocols have been established for diffuse crescentic glomerulonephritis, there is no standard treatment for patients with fewer crescents in renal biopsies. In this study the importance of crescent percentage and clinical features on renal survival independent of underlying disease was investigated. METHODS: This retrospective observational study was conducted between 2013 and 2017. Forty-nine patients with crescent formation in their kidney biopsies were evaluated. We compared clinicopathological features and renal survival. We evaluated the factors affecting the course of end stage renal disease (ESRD). RESULTS: A total of 49 patients (57% male and median age 49 years) were enrolled in this study. 39% of patients developed ESRD at follow-up. Logistic regression analysis showed that the requirement for renal replacement treatment on admission (p < 0.001), serum creatinine level above 2.7 mg/dL (p < 0.001), the presence of more than 50% glomerulosclerosis (p = 0.04) and more than 34% crescent formation (p = 0.002) were significantly associated with ESRD. Kaplan-Meier survival analysis revealed that patients with less than 34% crescent in kidney biopsy and a serum creatinine level less than 2.7 mg/dL had increased kidney survival (log-rank test p: 0.01 and p: 0.002). CONCLUSION: Patients with crescent formation in kidney biopsy more than 34% should be evaluated for more aggressive treatment modalities regardless of the underlying disease, especially if the serum creatinine level is above 2.7 mg/dL.


Assuntos
Creatinina/sangue , Glomerulonefrite/patologia , Glomerulosclerose Segmentar e Focal/patologia , Falência Renal Crônica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Progressão da Doença , Feminino , Glomerulonefrite/sangue , Glomerulonefrite/complicações , Glomerulonefrite/terapia , Humanos , Rim/patologia , Falência Renal Crônica/sangue , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
PLoS One ; 14(4): e0215942, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039171

RESUMO

PURPOSE: End-stage renal disease (ESRD) patients exhibit silent white-matter alterations after long-term hemodialysis, which may be due to ESRD itself or the hemodialysis. The purpose of this study was to investigate the longitudinal white-matter alterations in the ESRD patients under 3-year long-term hemodialysis using voxel-wise analysis of diffusion tensor imaging (DTI). MATERIALS AND METHODS: 15 ESRD patients and 15 age-matched healthy controls participated in this study. Due to the development of abnormal brain lesions in some cases, 13 ESRD patients and 13 age-matched healthy controls were enrolled and underwent cognitive function assessment and DTI acquisition at two-time points separated by 3 years. Voxel-based analysis was performed to globally detect white-matter alterations between the two groups as well as between the two scans within the two groups. RESULTS: In the ESRD patients, diffusivity indices were significantly increased and the fractional anisotropy was significantly decreased in both scans, as compared with healthy controls. Longitudinal comparisons showed significant white-matter alterations in healthy controls in three years, but little or no significant alterations were noted in the ESRD patients after additional 3-year hemodialysis. CONCLUSION: Poorer white matter integrity and cognitive function are noted in ESRD patients and the toxic effect of ESRD may be the major factor of white matter alterations.


Assuntos
Imagem de Tensor de Difusão , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/patologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adulto , Fatores Etários , Estudos de Casos e Controles , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/patologia , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Estudos Longitudinais , Masculino
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