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1.
Transplant Proc ; 51(6): 1822-1830, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399167

RESUMO

OBJECTIVES: The aim of the study was to compare the effects of a physical activity program on daily physical activity and quality of life in kidney transplant (KTx) recipients and in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: The study group consisted of 24 KTx recipients and 15 patients with stage 3 to 4 CKD. Habitual physical activity was monitored for 72 hours. Individualized structured programs of increased physical activity were prepared based on baseline physical performance. The measurements were repeated after 1 and 3 months. Participants completed the 36-item Short Form Health Survey questionnaire and an International Physical Activity Questionnaire at baseline and after 1, 2, and 3 months. RESULTS: Physical activity duration and total energy expenditure significantly increased after 3 months in both KTx recipients (from 126 ± 87 to 200 ± 132 min/d, P = .001, and from 1.73 ± 0.37 to 2.24 ± 0.59 cal/min, P < .001, respectively) and CKD patients (from 79 ± 78 to 129 ± 114 min/d, P < .001, and from 1.5 ± 0.5 to 1.92 ± 0.47 cal/min, P < .001, respectively). Short Form Health Survey total score and physical component scale score improved significantly in both groups. Mental component scale score increased significantly only in KTx patients. CONCLUSION: Increased physical activity induces similar beneficial effects on total and physical activity component of quality of life and habitual daily activity in CKD and KTx patients.


Assuntos
Terapia por Exercício/psicologia , Exercício , Transplante de Rim/reabilitação , Qualidade de Vida , Insuficiência Renal Crônica/reabilitação , Adulto , Terapia por Exercício/métodos , Feminino , Humanos , Transplante de Rim/psicologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/cirurgia , Inquéritos e Questionários , Transplantados/psicologia , Resultado do Tratamento
3.
Life Sci ; 233: 116666, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31325427

RESUMO

AIM: Pirfenidone (PFD) has been used as medication for idiopathic pulmonary fibrosis due to its ability in reducing lung fibrosis. However, the underlying mode of action in renal fibrosis during chronic renal allograft dysfunction (CRAD) requires further investigation. Therefore, the present study was conducted to explore the effects of PFD on renal injury induced by CRAD. MAIN METHODS: Initially, the CRAD rat model was established, followed by the intragastric administration of PFD to the rats. Urine and blood samples were collected and tested against indicators of renal functions. The renal tissues were microscopically observed to determine the changes in pathological morphology. The anti-inflammatory, anti-fibrotic and anti-oxidant properties of PFD were explored in the setting of CRAD. KEY FINDINGS: The success rate of model establishment was 92.31%, which was reflected by weight loss, appetite loss, faded fur, and retarded reaction, with the symptoms found to exacerbate with time. PFD treatment could improve renal function, ameliorate inflammation and renal fibrosis as well as promote the anti-oxidant ability of renal allograft, indicating its potential role as an effective therapeutic agent for CRAD. SIGNIFICANCE: In conclusion, PFD was found to have renoprotective effects on renal injury induced by CRAD, which resulted in the alleviation of inflammation and renal fibrosis, providing novelty for CRAD clinical treatment.


Assuntos
Fibrose/prevenção & controle , Rejeição de Enxerto/prevenção & controle , Transplante de Rim/efeitos adversos , Túbulos Renais/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Piridonas/farmacologia , Insuficiência Renal Crônica/cirurgia , Aloenxertos , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Doença Crônica , Fibrose/etiologia , Rejeição de Enxerto/etiologia , Túbulos Renais/patologia , Masculino , Ratos , Ratos Endogâmicos F344 , Ratos Endogâmicos Lew
4.
Braz J Cardiovasc Surg ; 34(3): 279-284, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310465

RESUMO

OBJECTIVE: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. METHODS: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). RESULTS: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). CONCLUSION: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.


Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/mortalidade , Procedimentos Endovasculares/métodos , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/cirurgia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/cirurgia , Valores de Referência , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/cirurgia , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento
5.
Int Braz J Urol ; 45(5): 1073-1074, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136105

RESUMO

OBJECTIVE: To report our step-by-step technique for robotic partial nephrectomy using intracorporeal renal hypothermia (RPNIRH) in a highly complex renal mass. The robotic technology has allowed surgeons to recreate the principles of open surgery in a minimally invasive approach (1). With increasing experience, larger deeply infiltrative tumors can be treated with this technique (2). In complex cases, when a long warm ischemia time is expected, intracorporeal renal hypothermia can be useful to prevent permanent renal function loss (3).


Assuntos
Carcinoma de Células Renais/cirurgia , Hipotermia Induzida/métodos , Gelo , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Isquemia Fria , Humanos , Masculino , Duração da Cirurgia , Insuficiência Renal Crônica/cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento
6.
Int Braz J Urol ; 45(4): 765-774, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136109

RESUMO

OBJECTIVES: To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL. MATERIALS AND METHODS: Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0-2] were included in the study. RESULTS: A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not signifi cant enough to cause stage migration. Again 3 (17.65%), 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not signifi cant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the fi nal follow up visit (6 months). CONCLUSION: Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Insuficiência Renal Crônica/cirurgia , Adolescente , Adulto , Idoso , Criança , Creatinina/sangue , Receptores ErbB/sangue , Estudos de Viabilidade , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Cálculos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Insuficiência Renal Crônica/fisiopatologia , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Urinálise , Adulto Jovem
7.
Nat Commun ; 10(1): 1906, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015506

RESUMO

Studying immune repertoire in the context of organ transplant provides important information on how adaptive immunity may contribute and modulate graft rejection. Here we characterize the peripheral blood immune repertoire of individuals before and after kidney transplant using B cell receptor sequencing in a longitudinal clinical study. Individuals who develop rejection after transplantation have a more diverse immune repertoire before transplant, suggesting a predisposition for post-transplant rejection risk. Additionally, over 2 years of follow-up, patients who develop rejection demonstrate a specific set of expanded clones that persist after the rejection. While there is an overall reduction of peripheral B cell diversity, likely due to increased general immunosuppression exposure in this cohort, the detection of specific IGHV gene usage across all rejecting patients supports that a common pool of immunogenic antigens may drive post-transplant rejection. Our findings may have clinical implications for the prediction and clinical management of kidney transplant rejection.


Assuntos
Linfócitos B/imunologia , Rejeição de Enxerto/imunologia , Hospedeiro Imunocomprometido , Transplante de Rim , Polimorfismo Genético/imunologia , Receptores de Antígenos de Linfócitos B/imunologia , Insuficiência Renal Crônica/imunologia , Adolescente , Adulto , Linfócitos B/patologia , Criança , Pré-Escolar , Células Clonais , Feminino , Expressão Gênica , Rejeição de Enxerto/genética , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/genética , Humanos , Lactente , Rim/imunologia , Rim/patologia , Rim/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Receptores de Antígenos de Linfócitos B/genética , Insuficiência Renal Crônica/genética , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/cirurgia , Análise de Sequência de DNA
8.
Nefrología (Madrid) ; 39(2): 141-150, mar.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181321

RESUMO

Introducción: El tratamiento renal conservador (TRC) se ha convertido en una opción terapéutica en la enfermedad renal crónica avanzada en ancianos. Se sabe poco sobre la evolución pronóstica de estos pacientes en términos de supervivencia y calidad de vida relacionada con la salud (CVRS). Objetivo: Establecer variables predictivas de mortalidad y analizar la CVRS en los pacientes en TRC. Pacientes y métodos: Estudio de cohortes prospectivo. Se realizó una valoración de parámetros de función renal y evaluación geriátrica integral: análisis de comorbilidad, situación funcional, cognitiva, fragilidad, nutricional, social y CVRS. Resultados: Se evaluaron 82 pacientes, con una edad media de 84 años e importante pluripatología: el 56% tenía antecedentes de evento vascular y Charlson > 8. La tasa de mortalidad fue de 23/1.000 pacientes-mes, con un ritmo de mortalidad homogéneo a partir de los 6 meses. La supervivencia difirió significativamente si presentaban evento vascular previo (36,7 vs. 14,8; p = 0,028), Charlson ≥10 (42 vs. 17; p = 0,002), grado de dependencia (48,4 vs. 19; p = 0,002) y fragilidad (27 vs. 10; p = 0,05). Fueron predictores de mortalidad: eFG y proteinuria, presencia de evento vascular previo, comorbilidad de Charlson, parámetros de malnutrición-inflamación (albúmina y puntuación MNA), grado de dependencia, CVRS física y aumento de PTH. La presencia de evento vascular previo, comorbilidad, albúmina descendida y elevación de PTH fueron predictores independientes de mortalidad. La CVRS se mantuvo estable y no se produjo empeoramiento significativo durante el tratamiento. Conclusiones: El conocimiento de los factores asociados con mortalidad y la evaluación de la CVRS puede ser útil como herramienta en la toma de decisiones en TRC. La presencia de evento vascular previo, comorbilidad, albúmina disminuida y el aumento de PTH fueron predictores independientes de mortalidad


Introduction: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). Objective: Establish predictive variables associated with mortality and analyse HRQoL in CM patients. Patients and methods: Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. Results: 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson > 8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months. Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p = 0.028), Charlson score ≥10 (42 vs. 17; p = 0.002), functional status (48.4 vs. 19; p = 0.002) and fragility (27 vs. 10; p = 0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. Conclusions: Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Sobrevivência , Qualidade de Vida , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/cirurgia , Estudos de Coortes , Estudos Prospectivos
9.
Transplant Proc ; 51(2): 324-327, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879533

RESUMO

BACKGROUND: The development of chronic kidney disease is a common complication after a lung transplantation, especially since the introduction of immunosuppressive treatments based on calcineurin inhibitors. Many of these patients reach end-stage renal disease and even need renal replacement therapy. Among the different options of renal replacement therapy, we consider kidney transplantation as a feasible option for these patients. METHODS: A single center, observational retrospective study including 8 lung transplanted patients who have received a kidney transplant in the period between 2013 and 2017 with at least 1 year of follow-up was used. RESULTS: Seven patients maintained an adequate function of the graft 1 year after kidney transplantation, and 1 patient died because of a pulmonary condition in spite of a previous kidney transplant. Two patients presented delayed graft function in the first days after surgery. CONCLUSIONS: The kidney transplantation is a technique of renal replacement therapy that should be considered in patients with previous lung transplantation. Experienced centers in double sequential lung and kidney transplantation should be established to assess and treat these types of patients.


Assuntos
Transplante de Rim/métodos , Transplante de Pulmão , Insuficiência Renal Crônica/cirurgia , Adulto , Idoso , Inibidores de Calcineurina/efeitos adversos , Função Retardada do Enxerto/epidemiologia , Feminino , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/induzido quimicamente , Estudos Retrospectivos
10.
Ann Transplant ; 24: 123-131, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30833537

RESUMO

BACKGROUND Anemia is present even in long-term observation after kidney transplantation. Observational study results indicate the presence of chronic post-transplantation anemia in 1 in 3 recipients. An extreme form of erythroid line dysfunction is pure red cell aplasia (PRCA). It may be caused by immunosuppressive treatment per se or a side effect, opportunistic pathogen activation. Parvovirus B19 (PV B19) infection is quite likely the cause of refractory normocytic anemia in immunocompromised patients. CASE REPORT In this case report we discuss biological and clinical features of this phenomenon and the treatment strategies, based on 2 PRCA cases in kidney transplant recipients. Additionally, a systematic review of published reports of PV B19 related PRCA in kidney recipients is presented. CONCLUSIONS PV replication should be ruled out in cases of persistent and/or refractory anemia after kidney transplantation. The established first-line treatment of PRCA is passive immunization. Taking into account cost effectiveness, a decrease in immunosuppression load is reasonable under careful control of allograft function.


Assuntos
Eritema Infeccioso/complicações , Transplante de Rim/efeitos adversos , Parvovirus B19 Humano/isolamento & purificação , Aplasia Pura de Série Vermelha/etiologia , Insuficiência Renal Crônica/cirurgia , Adulto , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Complicações Pós-Operatórias/etiologia , Aplasia Pura de Série Vermelha/virologia , Transplantados
11.
Intern Med ; 58(13): 1953-1960, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30918174

RESUMO

An 83-year-old man with stable chronic kidney disease (CKD) exhibited a sudden increase in urinary N-acetyl-ß-D-glucosaminidase and protein excretion, suggesting aggravated kidney damage. Simultaneously, he lost diabetic control, requiring up to 54 units of insulin daily. A detailed examination revealed the presence of renal cell carcinoma, which was surgically resected and confirmed to be interleukin-6-positive by immunohistochemistry. Postoperatively, his uni-nephrectomy necessitated hemodialysis, but the patient's insulin resistance was ameliorated; no medication was required to control diabetes, suggesting that the tumor had caused the insulin resistance. This report describes a case of a tumor secreting interleukin-6, which affects both the control of diabetes and CKD progression.


Assuntos
Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/cirurgia , Hexosaminidases/urina , Interleucina-6/metabolismo , Neoplasias Renais/cirurgia , Neoplasias Renais/urina , Síndromes Endócrinas Paraneoplásicas/cirurgia , Insuficiência Renal Crônica/cirurgia , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Progressão da Doença , Humanos , Masculino , Nefrectomia/métodos , Síndromes Endócrinas Paraneoplásicas/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Resultado do Tratamento
12.
J Orthop Surg Res ; 14(1): 82, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894199

RESUMO

PURPOSE: Chronic kidney disease (CKD) is known to increase morbidity and mortality after orthopedic surgery. The purpose of this study is to investigate how CKD affects perioperative complications in hip surgery patients. MATERIAL AND METHODS: From 2013 to 2016, a total of 230 patients (30 patients with CKD and 200 without CKD) undergoing hip surgery were enrolled in this study. Preoperative, intraoperative, and postoperative data was collected and analyzed between CKD and non-CKD patients. Logistic regression was used to evaluate the independent risk factor for postoperative complications. RESULTS: There were significant differences in the number of people with hypertension (90.0% vs 27.3%, P < 0.001), diabetes (33.3% vs 8.7%, P = 0.01), coronary heart disease (20.0% vs 2.0%, P = 0.001), smoking habits (56.7% vs 22.7%, P = 0.016), anemia (90.0% vs 19.3%, P < 0.001), and low hemoglobin levels (94.1 ± 19.7 vs 121.3 ± 18.8, P < 0.001) between CKD and non-CKD patients before surgery. Receiving a blood transfusion was significantly more common in CKD patients (50% vs 28.5%, P = 0.018). Postoperatively, significant differences were detected in the average number of patients who transferred to the ICU (73.3% vs 19.3%, P < 0.001). Furthermore, differences were found in the quantity of hemoglobin (92.5 ± 16.8 vs 107.5 ± 18.3, P < 0.001) and albumin (32.4 ± 4.1 vs 34.9 ± 5.5, P = 0.02) measured between CKD and non-CKD patients. Logistic regression analysis indicated that diabetes, alcohol, and anemia were all independent risk factors for obtaining a blood transfusion, while age, CKD, and osteoporosis were all independent risk factors for ICU transfers. CONCLUSION: Compared with non-CKD patients, CKD patients were accompanied with more cardiac diseases preoperatively. In addition, CKD patients were more likely to receive a blood transfusion and transfer to the ICU after hip surgery. Preoperative anemia should be restored sufficiently to decrease the incidence of blood transfusions.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Ossos Pélvicos/cirurgia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/tendências , Ossos Pélvicos/patologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
13.
Anatol J Cardiol ; 21(3): 134-141, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30821713

RESUMO

OBJECTIVE: Catheter-based renal sympathetic denervation (RDN) is implemented as a strategy to treat resistant hypertension. Serum creatinine and estimated glomerular filtration rate have some limitations to predict the early stage of acute kidney injury (AKI). We investigated the changes of early inflammatory biomarkers in AKI following the RDN procedure. METHODS: Twenty-five female swine were divided into three groups: normal control (Normal, n=5), sham-operated (Sham, n=5), and RDN groups (RDN, n=15). The RDN group was further subdivided into three subgroups according to the time of sacrifice: immediately (RDN-0, n=5), 1 week (RDN-1, n=5), and 2 weeks (RDN-2, n=5) after RDN. Renal cortical tissue was harvested, and clinical parameters and inflammatory biomarkers were checked. RESULTS: There were no significant changes in the clinical parameters between the normal control and sham-operated groups using contrast media. Inflammatory interleukin (IL)-1ß, IL-18, IL-6, tumor necrosis factor-α, and anti-inflammatory IL-10 increased immediately and then decreased at week 2 after RDN in the renal cortical tissue. Leaderless protein, IL-1α level, increased at week 1 and then decreased at week 2 after RDN. Caspase-1 increased immediately after RDN until week 2. Apoptosis-associated speck-like protein containing a caspase recruitment domain and NLRP3 expressions increased immediately and then decreased at week 2 after RDN. CONCLUSION: The RDN could induce acute renal inflammation through the activation of caspase-1 and NLRP3 inflammasome.


Assuntos
Caspase 1/metabolismo , Hipertensão/cirurgia , Rim/inervação , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Insuficiência Renal Crônica/cirurgia , Animais , Modelos Animais de Doenças , Feminino , Hipertensão/sangue , Hipertensão/fisiopatologia , Interleucina-1beta/sangue , Rim/patologia , Suínos , Simpatectomia
14.
PLoS One ; 14(2): e0212750, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794652

RESUMO

The HLA-G and MICA genes are stimulated under inflammatory conditions and code for soluble (sMICA and sHLA-G) or membrane-bound molecules that exhibit immunomodulatory properties. It is still unclear whether they would have a synergistic or antagonistic effect on the immunomodulation of the inflammatory response, such as in chronic kidney disease (CKD), contributing to a better prognosis after the kidney transplantation. In this study, we went from genetic to plasma analysis, first evaluating the polymorphism of MICA, NKG2D and HLA-G in a cohort from Southern Brazil, subdivided in a control group of individuals (n = 75), patients with CKD (n = 94), and kidney-transplant (KT) patients (n = 64). MICA, NKG2D and HLA-G genotyping was performed by polymerase chain reaction with specific oligonucleotide probes, Taqman and Sanger sequencing, respectively. Levels of soluble forms of MICA and HLA-G were measured in plasma with ELISA. Case-control analysis showed that the individuals with haplotype HLA-G*01:01/UTR-4 have a lower susceptibility to develop chronic kidney disease (OR = 0.480; p = 0.032). Concerning the group of kidney-transplant patients, the HLA-G genotypes +3010 GC (rs1710) and +3142 GC (rs1063320) were associated with higher risk for allograft rejection (OR = 5.357; p = 0.013 and OR = 5.357, p = 0.013, respectively). Nevertheless, the genotype +3010 GG (OR = 0.136; p = 0.041) was associated with kidney allograft acceptance, suggesting that it is a protection factor for rejection. In addition, the phenotypic analysis revealed higher levels of sHLA-G (p = 0.003) and sMICA (p < 0.001) in plasma were associated with the development of CKD. For patients who were already under chronic pathological stress and underwent a kidney transplant, a high sMICA (p = 0.001) in pre-transplant proved to favor immunomodulation and allograft acceptance. Even so, the association of genetic factors with differential levels of soluble molecules were not evidenced, we displayed a synergistic effect of sMICA and sHLA-G in response to inflammation. This increase was observed in CKD patients, that when undergo transplantation, had this previous amount of immunoregulatory molecules as a positive factor for the allograft acceptance.


Assuntos
Rejeição de Enxerto/genética , Antígenos HLA-G/genética , Antígenos de Histocompatibilidade Classe I/genética , Transplante de Rim , Polimorfismo Genético , Insuficiência Renal Crônica/genética , Adulto , Aloenxertos , Estudos de Casos e Controles , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/patologia , Antígenos HLA-G/imunologia , Antígenos de Histocompatibilidade Classe I/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Subfamília K de Receptores Semelhantes a Lectina de Células NK/genética , Subfamília K de Receptores Semelhantes a Lectina de Células NK/imunologia , Insuficiência Renal Crônica/imunologia , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/cirurgia , Fatores de Risco
15.
Exp Clin Transplant ; 17(Suppl 1): 153-155, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777543

RESUMO

Chronic kidney disease is defined as irreversible and progressive damage of the kidney. Chronicity is defined by the presence of renal dysfunction for at least 3 months, and renal dysfunction is defined through combinations of investigation (abnormal radiologic findings, abnormal urine or abnormal biochemistry reflecting renal dysfunction) and/or documentation of glomerular filtration rate below 60 mL/min/1.73 m². The case patient was a girl of 11 years of age, with diagnosis of chronic renal disease, of unknown cause, under renal replacement therapy with peritoneal dialysis, with progressive deterioration of general status and decrease of functional capacity and tolerance to physical activity, presence of fatigue, pulmonary congestion, retention of liquids, and edema in lower extremities, even with adjustment of medical treatment. Transplant was performed from a related living donor, without incidents or complications. The results of pediatric kidney trans plant are excellent, offering a high quality of life for recipients; many patients return to school. It is consi dered the criterion standard for the treatment of pediatric endstage renal disease with excellent allograft function and subsequent resolution of systolic dysfunction.


Assuntos
Insuficiência Cardíaca/etiologia , Transplante de Rim , Rim/cirurgia , Insuficiência Renal Crônica/cirurgia , Criança , Progressão da Doença , Ecocardiografia , Feminino , Taxa de Filtração Glomerular , Nível de Saúde , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Rim/fisiopatologia , Recuperação de Função Fisiológica , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Função Ventricular
16.
J Am Soc Nephrol ; 30(2): 201-215, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30655312

RESUMO

BACKGROUND: Whole-exome sequencing (WES) finds a CKD-related mutation in approximately 20% of patients presenting with CKD before 25 years of age. Although provision of a molecular diagnosis could have important implications for clinical management, evidence is lacking on the diagnostic yield and clinical utility of WES for pediatric renal transplant recipients. METHODS: To determine the diagnostic yield of WES in pediatric kidney transplant recipients, we recruited 104 patients who had received a transplant at Boston Children's Hospital from 2007 through 2017, performed WES, and analyzed results for likely deleterious variants in approximately 400 genes known to cause CKD. RESULTS: By WES, we identified a genetic cause of CKD in 34 out of 104 (32.7%) transplant recipients. The likelihood of detecting a molecular genetic diagnosis was highest for patients with urinary stone disease (three out of three individuals), followed by renal cystic ciliopathies (seven out of nine individuals), steroid-resistant nephrotic syndrome (nine out of 21 individuals), congenital anomalies of the kidney and urinary tract (ten out of 55 individuals), and chronic glomerulonephritis (one out of seven individuals). WES also yielded a molecular diagnosis for four out of nine individuals with ESRD of unknown etiology. The WES-related molecular genetic diagnosis had implications for clinical care for five patients. CONCLUSIONS: Nearly one third of pediatric renal transplant recipients had a genetic cause of their kidney disease identified by WES. Knowledge of this genetic information can help guide management of both transplant patients and potential living related donors.


Assuntos
Transplante de Rim/métodos , Medicina de Precisão/métodos , Insuficiência Renal Crônica/genética , Insuficiência Renal Crônica/cirurgia , Sequenciamento Completo do Exoma/métodos , Adolescente , Boston , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Predisposição Genética para Doença/epidemiologia , Testes Genéticos/métodos , Rejeição de Enxerto , Sobrevivência de Enxerto , Hospitais Pediátricos , Humanos , Transplante de Rim/efeitos adversos , Masculino , Prognóstico , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Transplantados/estatística & dados numéricos , Resultado do Tratamento
17.
PLoS One ; 14(1): e0210554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30653544

RESUMO

BACKGROUND: The incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking. OBJECTIVE: To investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery. DESIGN: A population-based study covering the period from January 1, 1997, to December 31, 2011. SETTING: Data from the Taiwan National Health Insurance Research Database. PARTICIPANTS: Participants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011. RESULTS: AMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62-1.98), male (OR: 1.42; 95% CI: 1.28-1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44-1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68-2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26-1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30-1.47) were all associated with AMI in the patients with CKD. CONCLUSIONS: The AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.


Assuntos
Infarto do Miocárdio/epidemiologia , Vigilância da População/métodos , Insuficiência Renal Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ortopedia , Período Perioperatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Fatores de Risco , Taiwan/epidemiologia
18.
Exp Clin Transplant ; 17(1): 31-36, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29251578

RESUMO

OBJECTIVES: Cervical cytology screening has been successful in reducing deaths from cervical cancer. We sought to determine risk factors for abnormal Pap test results in women undergoing kidney transplant evaluation. MATERILAS AND METHODS: We retrospectively examined women undergoing kidney transplant evaluations from 2008 to 2011. Patients were stratified based on normal cytology and atypical/malignant cytology. RESULTS: Of 404 patients, 293 patients (72.5%) had normal cytologic findings, whereas 111 (27.5%) had abnormal findings. On univariate logistic regression analyses, patients who had chronic kidney disease with an autoimmune cause (odds ratio = 2.71 [95% confidence interval, 1.41-5.19]; P = .003), previous renal transplants (odds ratio = 2.64 [95% confidence interval, 1.20-5.82], P = .016), or age ≤ 50 years (odds ratio = 1.68 [95% confidence interval, 1.08-2.61], P = .022) were more likely to have abnormal findings. Patients with normal and abnormal findings had similar rates of dialysis use. On multivariate logistic regression, patients who had chronic kidney disease with autoimmune causes (odds ratio = 2.48 [95% confidence interval, 1.26-4.88]; P = .008) and who had previous renal transplants (odds ratio = 2.67 [95% confidence interval, 1.20-5.95]; P = .017) were more likely to have abnormal findings. CONCLUSIONS: Previous kidney transplant, autoimmune disease, and age ≤ 50 years were associated with abnormalities on cervical cancer screening in our female group of patients. Patients with these characteristics may benefit more from routine cervical cancer screening than other patients evaluated for kidney transplant.


Assuntos
Colo do Útero/patologia , Achados Incidentais , Transplante de Rim , Insuficiência Renal Crônica/cirurgia , Neoplasias do Colo do Útero/patologia , Adulto , Fatores Etários , Doenças Autoimunes/complicações , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Pessoa de Meia-Idade , Teste de Papanicolaou , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Neoplasias do Colo do Útero/etiologia , Esfregaço Vaginal
19.
Transpl Int ; 32(1): 75-83, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30118552

RESUMO

Estimating glomerular filtration rate (GFR) is important for clinical management and research studies in simultaneous pancreas-kidney transplantation (SPK) recipients. No study has specifically investigated the reliability of recent creatinine-based GFR estimating equations in this singular population. We assessed the performances of CKD-EPI, MDRD, Schwartz-2009, Schwartz-Lyon, Lund-Malmo and Full Age Spectrum equations for estimating GFR after SPK. 126 patients were included. GFR was measured by a reference method (mGFR) one year after SPK and estimated with the different equations from a standardized measure of serum creatinine. Relative bias, precisions, 10% and 30% accuracies (P30) were used to determine equations reliability. Ages ranged from 29 to 58. Mean mGFR was 56.3 ± 13.3 [23.6-92.5] ml/min/1.73 m2 . In the whole population, P30 of the CKD-EPI and MDRD equations were 42% (38.0; 46.0) and 65% (61.5; 69) respectively. As compared to the other equations, the Schwartz-Lyon equation was significantly more accurate (P30 = 86.0% [83.5-88.0], P < 0.01) and less biased (1.13 [1.06-1.19], P < 0.01). Conclusions were similar whatever the age class (<40 or ≥40) and mGFR level (<60 or ≥60 ml/min/1.73 m2 ). This study suggests that the CKD-EPI and MDRD equations have poor performances in SPK recipients and that the Schwartz-Lyon equation is a reliable alternative.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Testes de Função Renal , Transplante de Rim/métodos , Transplante de Pâncreas/métodos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Insuficiência Renal Crônica/cirurgia , Reprodutibilidade dos Testes
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