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1.
PLoS One ; 15(11): e0242671, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33216775

RESUMO

Muscle depletion and sarcopenic obesity are related to a higher morbimortality risk in chronic kidney disease (CKD). We evaluated bed-side measures/indexes associated with low muscle mass, sarcopenia, obesity, and sarcopenic obesity in CKD and proposed cutoffs for each parameter. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People revised consensus applying dual energy X-ray absorptiometry (DXA) and hand grip strength (HGS), and obesity according to the International Society for Clinical Densitometry. Anthropometric parameters including calf (CC) and waist (WC) circumferences and WC/height (WC/H); bioelectrical impedance data including appendicular fat free mass (AFFM) and fat mass index (FMI) were assessed. ROC analysis and area under the curve (AUC) were applied for performance analyses. AFFM and CC presented the best performances for low muscle mass diagnosis-AFFM AUC for women was 0.96 and for men, 0.94, and CC AUC for women was 0.89 and for men, 0.85. FMI and WC/H were the best parameters for obesity diagnosis-FMI AUC for women was 0.99 and for men, 0.96, and WC/H AUC for women was 0.94 and for men, 0.95. The cutoffs (sensibility and specificity, respectively) for women were AFFM≤15.87 (90%; 96%), CC≤35.5 (76%; 94%), FMI>12.58 (100%; 93%), and WC/H>0.66 (91%; 84%); and for men, AFFM≤21.43 (98%; 84%), CC≤37 (88%; 69%), FMI>8.82 (93%; 88%), and WC/H>0.60 (95%; 80%). Sensibility and specificity for sarcopenia diagnosis were for AFFM+HGS in women 85% and 99% and in men, 100% and 99%; for CC+HGS in women 85% and 99% and in men, 100% and 100%; and for sarcopenic obesity were for FMI+AFFM in women 75% and 97% and in men, 75% and 95%. The tested bed-side measures/indexes presented excellent performance.


Assuntos
Força da Mão , Transplante de Rim , Obesidade , Diálise Renal , Insuficiência Renal Crônica , Sarcopenia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/diagnóstico por imagem , Obesidade/fisiopatologia , Obesidade/cirurgia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/cirurgia , Sarcopenia/diagnóstico , Sarcopenia/diagnóstico por imagem , Sarcopenia/fisiopatologia , Sarcopenia/cirurgia
2.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026201

RESUMO

Coronavirus disease 2019 is an infectious respiratory syndrome caused by the virus called SARS-CoV-2, belonging to the family of coronaviruses. The first ever cases were detected during the 2019-2020 pandemic. Coronaviruses can cause a common cold or more serious diseases such as Middle Eastern Respiratory Syndromes (MERS) and Severe Acute Respiratory Syndrome (SARS). They can cause respiratory, lung and gastrointestinal infections with a mild to severe course, sometimes causing the death of the infected person. This new strain has no previous identifiers and its epidemic potential is strongly associated with the absence of immune response/reactivity and immunological memory in the world population, which has never been in contact with this strain before. Most at risk are the elderly, people with pre-existing diseases and/or immunodepressed, dialyzed and transplanted patients, pregnant women, people with debilitating chronic diseases. They are advised to avoid contacts with other people, unless strictly necessary, and to stay away from crowded places, also observing scrupulously the recommendations of the Istituto Superiore di Sanità. In this article we detail the recommendations that must be followed by the nursing care staff when dealing with chronic kidney disease patients in dialysis or with kidney transplant patients. We delve into the procedures that are absolutely essential in this context: social distancing of at least one meter, use of PPI, proper dressing and undressing procedures, frequent hand washing and use of gloves, and finally the increase of dedicated and appropriately trained health personnel on ward.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Transplante de Rim/enfermagem , Pandemias , Pneumonia Viral/enfermagem , Guias de Prática Clínica como Assunto , Diálise Renal/enfermagem , Insuficiência Renal Crônica/enfermagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Desinfecção , Desinfecção das Mãos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Resíduos de Serviços de Saúde , Processo de Enfermagem/normas , Registros de Enfermagem , Pandemias/prevenção & controle , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Precauções Universais
4.
J Korean Med Sci ; 35(20): e166, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449324

RESUMO

BACKGROUND: Post-transplant cancer (PTC) is a critical complication after kidney transplantation. However, whether successfully cured PTC affects the long-term graft outcome remains unclear. METHODS: We retrospectively reviewed 1,629 kidney transplant recipients from 1995 to 2017 after excluding patients with post-transplant hematologic or advanced non-curable cancers and who underwent allograft nephrectomy because of cancer. Cured PTCs were defined as cancers treated with curative methods and/or adjuvant therapy without recurrence during ≥ 2 years. Propensity score matching was performed to match cured PTC patients with cancer-naïve patients (i.e., non-PTC group). RESULTS: During the median period of 7 years (maximum, 23 years), 70 patients (4.3%) had cured PTCs. The PTC group showed significantly higher risks of death-censored graft failure (adjusted hazard ratio [HR], 2.56 [1.05-6.23]), class II donor-specific antibodies (adjusted HRs, 3.37 [1.30-8.71]), estimated glomerular filtration rate < 30 mL/min/1.73 m² (adjusted HR, 2.68 [1.43-5.02]) and random urine protein/creatinine ratio > 1 g (adjusted HR, 3.61 [1.92-6.79]) compared to non-PTC group. However, the risk of mortality was not different between the PTC and non-PTC groups. According to the cancer type, only urogenital cancer had a significant association with graft failure (adjusted HR, 4.26 [1.19-15.22]) and the gastrointestinal cancer showed elevated risk of T cell mediated rejection compared to non-PTC (adjusted HR, 20.44 [6.02-69.39]). CONCLUSION: Appropriate monitoring of graft function is necessary in patients with cured PTCs.


Assuntos
Rejeição de Enxerto , Transplante de Rim , Insuficiência Renal Crônica/cirurgia , Adulto , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Transplante Homólogo , Resultado do Tratamento
5.
Arq Gastroenterol ; 57(1): 45-49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294735

RESUMO

BACKGROUND: Direct-acting antivirals have revolutionized hepatitis C treatment, also for patients with chronic kidney disease (CKD), but some controversy exists regarding the use of sofosbuvir (SOF) in patients with glomerular filtration rate (GFR) <30 mL/min. OBJECTIVE: To evaluate the efficacy and safety of these regimens for hepatitis C treatment of patients with CKD and after renal transplantation, as well as the impact of SOF on renal function in non-dialysis patients. METHODS: All patients with hepatitis C and CKD or renal transplant treated with direct-acting antivirals at a referral center in Brazil between January 2016 and August 2017 were included. Efficacy was evaluated based on viral load (HCV RNA) and a sustained virological response (SVR) consisting of undetectable RNA 12 and/or 24 weeks after the end of treatment (SVR12 and SVR24) was defined as cure. Safety was determined by adverse events and ribavirin, when combined, was administered in escalating doses to all patients with GFR <60 mL/min. The impact of SOF on renal function was determined by the measurement of baseline creatinine during and after the end of treatment and its increase was evaluated using the Acute Kidney Injury Network (AKIN) classification. RESULTS: A total of 241 patients (52.7% females) with a mean age of 60.72±10.47 years were included. The combination of SOF+daclatasvir was the predominant regimen in 75.6% of cases and anemia was present in 28% of patients who used ribavirin (P=0.04). The SVR12 and SVR24 rates were 99.3% and 97.1%, respectively. The treatment was well tolerated and there were no major clinically relevant adverse events, with the most prevalent being asthenia (57.7%), itching (41.1%), headache (40.7%), and irritability (40.2%). Among conservatively treated and renal transplant patients, oscillations of creatinine levels (AKIN I) were observed in 12.5% of cases during treatment and persisted in only 8.5% after the end of treatment. Of these, 2.0% had an initial GFR <30 mL/min and this percentage decreased to 1.1% after SOF use. Only 0.5% and 1.6% of the patients progressed to AKIN II and AKIN III elevation, respectively. CONCLUSION: The direct-acting antivirals were safe and efficacious in CKD patients treated with SOF-containing regimens, with the observation of high SVR rates, good tolerability and few severe adverse events. The combination with ribavirin increased the risk of anemia and the administration of escalating doses seems to be useful in patients with GFR <60 mL/min. In patients with GFR <30 mL/min, SOF had no significant renal impact, with serum creatinine returning to levels close to baseline after treatment.


Assuntos
Antivirais/administração & dosagem , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Transplante de Rim/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Genótipo , Taxa de Filtração Glomerular , Humanos , Imidazóis/administração & dosagem , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/cirurgia , Ribavirina/administração & dosagem , Simeprevir/administração & dosagem , Sofosbuvir/administração & dosagem , Resposta Viral Sustentada , Resultado do Tratamento , Carga Viral
6.
Adv Exp Med Biol ; 1244: 287-293, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32301023

RESUMO

With the increasing use of immunotherapy, there has been an associated increased survival in many cancers but has also resulted in unregulated organ-specific toxicities. In this chapter, we discuss the renal toxicities associated with a checkpoint inhibitor (CPI) from the typical acute tubulointersitial nephritis to glomerulonephritis, their proposed mechanisms, and treatments. We also discuss the use of CPI and reactivation of preexisting auto-immune diseases and focus on renal cell cancer in setting of Chronic kidney disease (CKD). Transplant rejection in the setting of CPI use is yet to be further studied, and available data is presented in this chapter.


Assuntos
Rejeição de Enxerto/induzido quimicamente , Imunoterapia/efeitos adversos , Neoplasias/terapia , Nefrite/induzido quimicamente , Rejeição de Enxerto/imunologia , Humanos , Neoplasias/complicações , Neoplasias/imunologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/cirurgia
7.
Transplant Proc ; 52(5): 1279-1283, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307144

RESUMO

Renal transplantation is the best long-term treatment option compared with maintenance dialysis in patients with chronic kidney disease. This treatment should be combined with immunosuppressive drugs to obtain positive effects; however, the adverse effects of these medications in the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients remain unknown. OBJECTIVE: The objective of this study is to evaluate the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients undergoing renal transplantation in the preoperative period and during the first 6 months of postoperative period. METHODS: The respiratory and peripheral muscle strength, quality of life, and functional capacity of 40 patients were evaluated from the pretransplant period to 6 months post-renal transplantation. RESULTS: Compared with the preoperative period, the patients experienced improvement of the respiratory and peripheral strength 6 months after transplant (maximal inspiratory pressure 44% and maximal expiratory pressure 28.96%, handgrip 13.81%, and lower limbs 26.95%) and also in the quality of life. CONCLUSION: We conclude that 6 months after transplant, patients showed improvement in respiratory and peripheral muscle strength and quality of life, but even with the improvement, patients presented an unsatisfactory quality of life and muscle strength, regardless of immunosuppressive therapy.


Assuntos
Imunossupressão/efeitos adversos , Transplante de Rim/efeitos adversos , Força Muscular/fisiologia , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Adulto , Feminino , Força da Mão , Humanos , Estudos Longitudinais , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Período Pós-Operatório , Insuficiência Renal Crônica/cirurgia , Músculos Respiratórios/fisiopatologia
8.
Transplant Proc ; 52(8): 2324-2330, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32334793

RESUMO

BACKGROUND: Disturbances in polyunsaturated fatty acids (PUFA) could predispose renal transplant (RTx) patients to cardiovascular risk. The purpose of this study was to evaluate serum content of ω-3 and ω-6 PUFA in RTx subjects, in comparison to nontransplanted chronic kidney disease (CKD) patients in predialysis stages and to healthy controls. In the second part of the study, PUFA were analyzed in subcutaneous adipose tissue of CKD subjects at the time of kidney transplantation. METHODS: The first part of the study was conducted in a cohort (n = 134) of 3 groups: patients after renal transplantation (RTx group, n = 24), patients with CKD in stages 2-5, not on dialysis (CKD-ND group, n = 67), and controls without CKD (control group, n = 43). The fatty acids (FA) assessed by gas chromatography-mass spectrometry (GC-MS) were alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), linoleic acid (LA), and arachidonic acid (AA). Diet was assessed by food frequency questionnaire FFQ-6. In the second part of the study, the same FA were evaluated in samples of adipose tissue taken during the kidney transplantation procedure and compared with FA of controls from the adipose tissue collected during hernia surgeries. RESULTS: The first part of the study showed that RTx patients presented significantly lower serum content of all the examined PUFA, in comparison to the CKD-ND group and controls. For instance, EPA in RTx equaled 0.65 ± 0.32%, in CKD-ND 0.82 ± 0.43%, and in controls 1.06 ± 0.68% (P = .005). No significant correlations were found between serum PUFA and diet in RTx patients. The second part of the study revealed no significant difference in the adipose tissue PUFA between CKD patients at the time of kidney transplantation and controls. CONCLUSIONS: RTx patients present with low serum content of potentially beneficial PUFA. This finding does not seem to be solely due to an altered diet. Observed disorders might result from immunosuppressive drugs or other, yet undetermined, causes.


Assuntos
Dieta/efeitos adversos , Ácidos Graxos Insaturados/sangue , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/sangue , Tecido Adiposo/química , Adulto , Estudos de Coortes , Inquéritos sobre Dietas , Ácidos Docosa-Hexaenoicos/sangue , Ácido Eicosapentaenoico/sangue , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-6/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Insuficiência Renal Crônica/cirurgia
9.
J Urol ; 204(3): 434-441, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32186436

RESUMO

PURPOSE: Partial nephrectomy is prioritized over radical nephrectomy in patients with chronic kidney disease whenever feasible. However, we hypothesized that some patients with severe chronic kidney disease might rapidly progress to end stage renal disease, in which case the morbidity that can be associated with partial nephrectomy would not be justified. MATERIALS AND METHODS: A retrospective review of all 62 patients with stage IV chronic kidney disease undergoing partial nephrectomy at our institution (1999-2015) was performed. We analyzed preoperative/intraoperative factors and postoperative outcomes. Survival-analyses evaluated factors associated with time-to-progression to end stage renal disease the primary end point. RESULTS: Median age was 67 years, 71% of patients were male, and 84% Caucasian. Comorbidities included hypertension (94%), cardiovascular disease (53%) and diabetes (32%). Median preoperative estimated glomerular filtration rate was 23 ml/minute/1.73 m2 and 73% had an open approach. Benign pathology was found in 10 (16%) patients; only 23 (37%) and 7 (11%) patients had tumor grade 3/4 or pT3a disease, respectively. Unfavorable outcomes occurred in 15 patients (24%) defined as either 90-day mortality (3%), postoperative complication Clavien IIIb or greater (14%), or positive surgical margin (12%). Median time to progression to end stage renal disease was only 27 months (58 months for preoperative glomerular filtration rate greater than 25 ml/minute/1.73 m2 versus only 14 months when preoperative glomerular filtration rate was less than 20 ml/minute/1.73 m2). On multivariable analysis African American race (HR 2.55 [1.10-5.95]), preoperative estimated glomerular filtration rate 20 to 25 ml/minute/1.73 m2 or less than 20 ml/minute/1.73 m2 (HR 2.59 [1.16-5.84] and 5.03 [2.03-12.4], respectively) and minimally invasive approach (HR 2.05 [1.01-4.19]) were independently associated with progression to end stage renal disease. CONCLUSIONS: Our data suggest that some patients with stage IV chronic kidney disease undergoing partial nephrectomy have substantial comorbidities and nonaggressive pathology, and are at risk for unfavorable perioperative outcomes and rapid-progression to end stage renal disease. Renal mass biopsy should be strongly considered to improve patient-selection. Alternate strategies (active surveillance or radical nephrectomy) may be more appropriate, particularly when partial nephrectomy is high complexity or when the patient is African American, or preoperative glomerular filtration rate is less than 25 ml/minute/1.73 m2.


Assuntos
Nefrectomia/métodos , Insuficiência Renal Crônica/cirurgia , Idoso , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Insuficiência Renal Crônica/mortalidade , Estudos Retrospectivos , Fatores de Risco
10.
Am J Kidney Dis ; 75(3): 299-316, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32007233

RESUMO

Living kidney donation is widely practiced throughout the world. During the past 2 decades, various groups have provided guidance about the evaluation and care of living donors. However, during this time, our knowledge in the field has advanced substantially and many agreed on the need for a comprehensive, unifying document. KDIGO (Kidney Disease: Improving Global Outcomes) addressed this issue at an international level with the publication of its clinical practice guideline on the evaluation and care of living kidney donors. The KDIGO work group extensively reviewed the available literature and wrote a series of guideline recommendations using various degrees of evidence when available. As has become recent practice, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) convened a work group to provide a commentary on the KDIGO guideline, with a focus on how these recommendations apply in the context of the United States. In the United States, the United Network for Organ Sharing (UNOS) guides and regulates the practice of living kidney donation. While the KDIGO guideline for the care of living kidney donors and UNOS policy are similar in most aspects of the care of living kidney donors, several important areas are not consistent or do not align with common practice by US transplantation programs in areas in which UNOS has not set specific policy. For the time being, and recognizing the value of the KDIGO guidelines, US transplantation programs should continue to follow UNOS policy.


Assuntos
Transplante de Rim/normas , Doadores Vivos , Guias de Prática Clínica como Assunto , Insuficiência Renal Crônica/cirurgia , Obtenção de Tecidos e Órgãos/normas , Humanos
11.
Transplant Proc ; 52(1): 140-145, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31901330

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is a pathophysiological process with many etiologic causes, often leading to end-stage renal disease (ESRD). The distribution of the causes that lead to ESRD varies by country, race, and sex. Renal failure may be prevented by determining these differences and reducing the risk factors. OBJECTIVE: The purpose of the study was to determine the causes and risk factors of previous ESRD in kidney transplant (KT) recipients. METHODS: In this descriptive, cross-sectional study, 393 KT recipients fitting the study criteria gave written consent to participate. Data were collected in face-to-face interviews at the Transplant Center using survey forms prepared by the researchers. RESULTS: According to a multivariate logistic regression analysis of the dependent variable of ESRD diagnosis age of KT recipients, the factors affecting ESRD diagnosis age were found to be job (Odds ratio (OD) = 5.76; 95% CI [2.291-14.481]), diabetes mellitus (DM) (OD = 2.94; 95% CI [1.143-7.571]), polycystic kidney disease (PKD) (OD = 4.55; 95% CI [1.737-11.919]), hypertension (HT) (OD = 3.53; 95% CI [2.132-5.854]), family history of ESRD (OD = 0.57; 95% CI [0.341-0.963]), surgical procedure history (OD = 1.93; 95% CI [1.150-3.230]), and stress level (OD = 5.86, 95% CI [2.212-15.528]). CONCLUSION: It is important that we determine the changeable risk factors related to ESRD development in order to prepare strategies aimed at preventing ESRD, the frequency and prevalence of which is gradually increasing. Modifiable risk factors should be identified, particularly in KT recipients, to preserve the functions of the transplanted kidney.


Assuntos
Falência Renal Crônica/etiologia , Transplante de Rim , Doenças Renais Policísticas/etiologia , Insuficiência Renal Crônica/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Doenças Renais Policísticas/epidemiologia , Doenças Renais Policísticas/cirurgia , Prevalência , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/cirurgia , Fatores de Risco
12.
BJU Int ; 125(3): 442-448, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31758657

RESUMO

OBJECTIVE: To analyse whether selective arterial clamping (SAC) and off-clamp (OC) techniques during robot-assisted partial nephrectomy (RPN) are associated with a renal functional benefit in patients with Stage 3-5 chronic kidney disease (CKD). PATIENTS AND METHODS: The change in estimated glomerular filtration rate (eGFR) over time was compared between 462 patients with baseline CKD 3-5 that underwent RPN with main arterial clamping (MAC) (n = 375, 81.2%), SAC (n = 48, 10.4%) or OC (n = 39, 8.4%) using a multivariable linear mixed-effects model. All follow-up eGFRs, including baseline and follow-up between 3 and 24 months, were included in the model for analysis. The median follow-up was 12.0 months (interquartile range 6.7-16.5; range 3.0-24.0 months). RESULTS: In the multivariable linear mixed-effects model adjusting for characteristics including tumour size and the R.E.N.A.L. (Radius; Exophytic/Endophytic; Nearness; Anterior/Posterior; Location) Nephrometry Score, the change in eGFR over time was not significantly different between SAC and MAC RPN (ß = -1.20, 95% confidence interval [CI] -5.45, 3.06; P = 0.582) and OC and MAC RPN (ß = -1.57, 95% CI -5.21, 2.08; P = 0.400). Only 20 (15 MAC, two SAC, three OC) patients overall had progression of their CKD stage at last follow-up. The mean ischaemia time was 17 min for MAC and 15 min for SAC. There was no benefit to SAC or OC in terms of blood loss, perioperative complications, length of stay, or surgical margins. CONCLUSION: SAC and OC techniques during RPN were not associated with benefit in preservation of eGFR in patients with baseline CKD.


Assuntos
Nefrectomia/métodos , Insuficiência Renal Crônica/cirurgia , Idoso , Constrição , Feminino , Humanos , Isquemia/prevenção & controle , Rim/irrigação sanguínea , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Artéria Renal , Índice de Gravidade de Doença
13.
Kidney Blood Press Res ; 45(1): 1-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31801144

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is an important independent risk factor for adverse cardiovascular events in patients waitlisted for kidney transplantation (KT). Although KT reduces cardiovascular risk, these patients still have a higher all-cause and cardiovascular mortality than the general population. This concerning situation is due to a high burden of traditional and nontraditional risk factors as well as uremia-related factors and transplant-specific factors, leading to 2 differentiated processes under the framework of CKD, atherosclerosis and arteriosclerosis. These can be initiated by insults to the vascular endothelial endothelium, leading to vascular calcification (VC) of the tunica media or the tunica intima, which may coexist. Several pathogenic mechanisms such as inflammation-related endothelial dysfunction, mineral metabolism disorders, activation of the renin-angiotensin system, reduction of nitric oxide, lipid disorders, and the fibroblast growth factor 23-klotho axis are involved in the pathogenesis of atherosclerosis and arteriosclerosis, including VC. SUMMARY: This review focuses on the current understanding of atherosclerosis and arteriosclerosis, both in patients on the waiting list as well as in kidney transplant recipients, emphasizing the cardiovascular risk factors in both populations and the inflammation-related pathogenic mechanisms. Key Message: The importance of cardiovascular risk factors and the pathogenic mechanisms related to inflammation in patients waitlisted for KT and kidney transplant recipients.


Assuntos
Doenças Cardiovasculares/etiologia , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/cirurgia , Doenças Vasculares/etiologia , Listas de Espera , Humanos , Transplante de Rim/mortalidade , Fatores de Risco
14.
Bol. pediatr ; 59(248): 98-107, 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-190954

RESUMO

El reflujo vesicoureteral (RVU) es la malformación nefrourológica más frecuente del recién nacido, pudiendo aparecer de forma secundaria en otras patologías malformativas, como en el caso de las valvas de uretra posterior, o ser secundario a una disfunción de la unión ureterovesical. De esta manera se distinguen dos fenotipos de pacientes, por un lado los diagnosticados en época prenatal o neonatal, generalmente varones, con afección anatómica y/o funcional de la unión ureterovesical, lo que se conoce con el nombre de "RVU primario", frente a formas postnatales en el escolar mayor, generalmente mujeres con disfunción vesical y de la unión ureterovesical, conocidas como "RVU secundario". Estas formas clínicas presentan distinta evo-lución clínica y pronóstico, con desarrollo de enfermedad renal crónica (ERC) debida a un mal desarrollo nefrourológico asociado o no a infecciones urinarias recurrentes. La técnica gold standard para diagnosticar daño renal es la gammagrafía renal DMSA Tc99 mientras que la prueba diagnóstica de RVU es la cistouretrografía miccional seriada (CUMS). El tratamiento inicial debe ser conservador optimizando medidas higiénicas, dada la posibilidad de resolución espontánea del mismo con el tiempo, principalmente de las formas leves de RVU, reservando el tratamiento quirúrgico correctivo en las formas severas y con mala evolución clínica, por el probable desarrollo de ERC que puede conducir al paciente a una enfermedad renal terminal con necesidad de técnicas de depuración extrarrenal o incluso trasplante renal. Dicho tratamiento quirúrgico será preferentemente endoscópico. Aún existe controversia en el uso de profilaxis antibiótica, recomendándose en casos concretos. Un manejo integral multidisciplinar del paciente mejorará su pronóstico renal y vital, así como su calidad de vida y la de su familia


Vesicoureteral reflux (VUR) is the most frequent nephrourological malformation of the newborn, and may appear secondary in other malformative pathologies, such as in the case of the posterior urethral leaflets, or be secondary to a dysfunction of the ureterovesical junction. In this way, two phenotypes of patients are distinguished, on the one hand those diagnosed in the prenatal or neonatal period, generally males, with anatomical and/or functional affection of the ureterovesical junction, which is known as the "primary VUR", compared to postnatal forms in the older schoolchild, generally women with bladder and ureterovesical junction dysfunction, known as "secondary VUR". These clinical forms present different clinical and prognostic evolution, with development of chronic kidney disease (CKD) due to poor nephrourological development frequently associated with recurrent urinary infections. The gold standard technique for diagnosing kidney damage is nuclear renal scanning with dimercaptosuccinic acid (DMSA), while the diagnostic test for VUR is voiding cystourethrography (VCUG). Initial treatment should be conservative, optimizing hygienic measures, given the possibility of spontaneous resolution of it over time, mainly in mild forms of VUR, reserving corrective surgical treatment in severe forms and with poor clinical evolution, due to the probable development of CKD that can lead the patient to end-stage kidney disease with the need for extrarenal clearance techniques or even kidney transplantation. Surgical treatment will preferably be endoscopic. There is still controversy in the use of antibiotic prophylaxis, being recommended in specificcases. A comprehensive multidisciplinary management of the patient will improve their renal and vital prognosis, as well as their quality of life and that of their family


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Refluxo Vesicoureteral/epidemiologia , Refluxo Vesicoureteral/cirurgia , Insuficiência Renal Crônica/cirurgia , Prognóstico , Cintilografia , Insuficiência Renal Crônica/diagnóstico por imagem , Refluxo Vesicoureteral/classificação , Insuficiência Renal Crônica/epidemiologia , Antibioticoprofilaxia , Proteinúria/complicações
15.
J. bras. nefrol ; 41(4): 570-574, Out.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1056613

RESUMO

Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.


Resumo A ocorrência de ascite no pós-Transplante Renal (TR) é infrequente, podendo ser consequência de complicações cirúrgicas ou médicas. Caso clínico: 61 anos, masculino, antecedentes de hipertensão arterial, carcinoma da língua e hábitos alcoólicos 12-20g/dia. Doença renal crônica secundária à doença renal poliquística autossômica dominante, sem poliquistose hepática. Submetido a TR de doador cadáver em setembro de 2017. Atraso na função de enxerto por estenose da artéria renal, corrigida cirurgicamente. Internado em janeiro de 2018 por ascite de novo, sem resposta a diuréticos. Circulação colateral abdominal visível. Disfunção do enxerto, tacrolinemia adequada. Sedimento urinário inocente. Anemia ligeira, sem trombocitopenia. Albumina sérica 4,0g/dL. Bioquímica hepática normal. Líquido peritoneal com características de transudado e gradiente sero-ascítico de albumina > 1,1. Ecografia com hepatomegalia, eixos vasculares permeáveis, sem esplenomegalia. Suspendeu micofenolato mofetil, reduziu restante imunossupressão. Manteve ascite refratária: excluídas etiologias infecciosas, metabólicas, autoimunes e neoplásicas. Sem proteinúria nefrótica e sem insuficiência cardíaca. RM: micronódulos compatíveis com quistos biliares. EDA sem varizes gastroesofágicas. Linfocintigrafia abdominal normal. Submetido a laparoscopia exploradora com biópsia hepática: cirrose septal incompleta de provável etiologia vascular, alguns ductos biliares dilatados. Manteve disfunção progressiva do TR, reiniciou hemodiálise. Proposta medição direta da pressão portal, protelada por resolução da ascite. Recuperação posterior da função de enxerto. Discussão: A cirrose septal incompleta é uma causa incomum de hipertensão portal não cirrótica. A sua definição é morfológica e a fisiopatologia, pouco conhecida. Não encontramos publicados casos de ascite pós-TR secundária a esta patologia, descrita como possivelmente associada a fármacos, alterações imunitárias, infecções, hipercoagulabilidade e predisposição genética.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Ascite/etiologia , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/cirurgia , Cirrose Hepática/patologia , Ascite/diagnóstico , Diálise Renal/normas , Rim Policístico Autossômico Dominante/complicações , Função Retardada do Enxerto/complicações , Hipertensão Portal/etiologia , Cirrose Hepática/complicações
16.
Enferm. nefrol ; 22(4): 388-397, oct.-dic. 2019. tab
Artigo em Português | IBECS | ID: ibc-188354

RESUMO

Introdução: considerando a prevalência de pacientes em terapia renal substitutiva, torna-se extremamente revelevante a avaliação da capacidade de entendimento e aplicacação das orientações que esses indíviduos recebem nos serviços de saúde. Objetivo: estudar o impacto do nível de letramento em saúde de pacientes submetidos à hemodiálise, diálise peritoneal e transplante renal, associado aos aspectos cognitivos, adesão medicamentosa e qualidade de vida. Material e Método: estudo transversal, realizado com indivíduos acima de 18 anos, submetidos a algum tipo de terapia renal substitutiva, há três meses consecutivos. Foram aplicadas as versões brasileiras dos instrumentos: Short Assessment of Health Literacy for Portuguese-speaking Adults-18, Mini Exame do Estado Mental, 36-Item Short Form e a escala de Morisky, além de um questionário sobre dados clínicos e sociodemográficos. Resultados: foram avaliados 138 pacientes, sendo 50 (36,2) submetidos à hemodiálise, 23 (16,7%) a diálise peritoneal e 65 (47,1%) ao transplante renal. A média de idade foi 52,0+/-15,5 anos e 58,0% do sexo masculino. Os pacientes com letramento inadequado (51,4%) tinham renda igual ou inferior a um salário mínimo (P=0,002) e ensino fundamental completo ou inferior (P<0,001). Os indivíduos com letramento adequado apresentavam ensino médio incompleto ou maior escolaridade, renda igual ou superior a cinco salários mínimos e maior escore no domínio dos aspectos emocionais referente a qualidade de vida (P=0,052). Conclusões: nossos resultados sugerem que o nível de letramento está associado com a renda e escolaridade nos pacientes que realizam a substituição da função renal


Introducción: Considerando la prevalencia de pacientes en tratamiento renal sustitutivo, es extremamente relevante la valoración de la capacidad de comprensión y aplicación de las orientaciones que esos individuos reciben en los servicios de salud. Objetivo: estudiar el impacto del nivel de alfabetización en salud de pacientes sometidos a hemodiálisis, diálisis peritoneal y trasplante renal, asociado a los aspectos cognitivos, adhesión a la medicación y calidad de vida. Material y Método: Estudio transversal, realizado con individuos mayores de 18 años, sometidos a algún tipo de tratamiento renal sustitutivo, durante al menos tres meses consecutivos. Fueron aplicadas las versiones brasileñas de los instrumentos: Short Assessment of Health Literacy for Portuguese-speaking Adults-18, "Mini Exame do Estado Mental, 36-Item Short Form y la Escala de Morisky, así como un cuestionario sobre datos clínicos y sociodemográficos. Resultados: se valoraron 138 pacientes, 50 (36,2%) sometidos a hemodiálisis, 23 (16,7%) a diálisis peritoneal y 65 (47,1%) trasplantados renales. La media de edad fue de 52,0+/-15,5 años y 58,0% del sexo masculino. Los pacientes con alfabetización en salud inadecuada (51,4%) tenían salario igual o inferior a un salario mínimo (P=0,002) y educación básica completa o inferior (P=0,001). Los individuos con alfabetización adecuada presentaban educación secundaria incompleta o mayor escolaridad, salario igual o superior a cinco salarios mínimos y mayor puntuación en el dominio de aspectos emocionales referentes a calidad de vida (P=0,052). Conclusiones: Nuestros resultados sugieren que el nivel de literacia en salud está asociado con el salario y escolaridad en los pacientes que realizan tratamiento renal sustitutivo


Introduction: Considering the prevalence of patients on renal replacement therapy, it is extremely revealing to evaluate the ability to understand and apply the guidelines that these individuals receive in health services. Objective: To study the impact of the health literacy level of patients on hemodialysis, peritoneal dialysis and kidney transplantation, associated with cognitive aspects, therapeutic adherence and quality of life. Material and Method: Cross-sectional study conducted with individuals over 18 years old, undergoing some type of renal replacement therapy, for three consecutive months. The Brazilian versions of the instruments were applied: Short Assessment of Health Literacy for Portuguese-speaking Adults-18, Mini Mental State Examination, 36-Item Short Form and the Morisky scale, as well as a questionnaire on clinical and sociodemographic data. Results: 138 patients were evaluated, 50 (36.2%) on hemodialysis treatment, 23 (16.7%) peritoneal dialysis and 65 (47.1%) renal transplantation. The average age was 52.0 +/- 15.5 years and 58.0% male. Patients with inadequate literacy (51.4%) had an income equal to or less than the minimum salary (P=0.002) and completed elementary school or lower (P<0.001). Individuals with adequate literacy had incomplete high school or higher education, income equal to or higher than five minimum salaries and higher score in the 'emotional aspects related to quality of life' domain (P=0.052). Conclusions: Our results suggest that the level of literacy is associated with income and education in patients undergoing renal function replacement


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Diálise Renal , Transplante de Rim , Letramento em Saúde/métodos , Qualidade de Vida , Estudos Transversais , Fatores Socioeconômicos
17.
BMC Nephrol ; 20(1): 414, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730449

RESUMO

BACKGROUND: Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease that requires vigilant treatment due to its high mortality rate. Pharmacologic therapy is recommended as an initial treatment; if there is no response, a total parathyroidectomy is performed. In some cases, surgery is accompanied by auto-transplantation of parathyroid tissue. CASE PRESENTATION: The patient was diagnosed with chronic kidney disease and received a kidney transplant. However, due to rejection of the transplanted kidney, medical nephrectomy was carried out and routine hemodialysis was initiated and observed. At this time, secondary hyperparathyroidism with elevated parathyroid hormone and hyperphosphatemia developed and pharmacologic treatment was applied. However, there was no response to pharmacologic treatment; therefore, total parathyroidectomy with auto-transplantation was performed. Eight years after surgery, a growing mass was observed in the transplantation site, accompanied by an elevation of parathyroid hormone. A complete resection of the mass was performed, and the patient was diagnosed with parathyroid carcinoma. Additional adjuvant radiation therapy was ordered, and the patient is being monitored. CONCLUSIONS: This is a rare but remarkable case of parathyroid carcinoma arising from auto-transplanted parathyroid tissue after total parathyroidectomy in a patient with secondary hyperparathyroidism. We suggest caution should be taken when choosing to auto- transplant parathyroid tissue and that careful postoperative observation should be performed.


Assuntos
Autoenxertos , Glândulas Paratireoides , Neoplasias das Paratireoides , Paratireoidectomia , Complicações Pós-Operatórias , Insuficiência Renal Crônica , Transplante Autólogo/efeitos adversos , Adulto , Autoenxertos/patologia , Autoenxertos/cirurgia , Rejeição de Enxerto/cirurgia , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Transplante de Rim/efeitos adversos , Masculino , Nefrectomia/efeitos adversos , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/etiologia , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/radioterapia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/radioterapia , Complicações Pós-Operatórias/cirurgia , Radioterapia Adjuvante , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/cirurgia , Transplante Autólogo/métodos , Resultado do Tratamento
18.
BMC Nephrol ; 20(1): 371, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619211

RESUMO

BACKGROUND: This study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFRCKD-EPI) to modification of diet in renal disease (eGFRMDRD) and the Cockcroft-Gault formulas of Creatinine clearance (CCG) equations in predicting post coronary artery bypass grafting (CABG) mortality. METHODS: Data from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores' performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. RESULTS: The discriminatory power was higher in eGFRCKD-EPI than eGFRMDRD and CCG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFRCKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m2 (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients (p = 0.53) and subjects with severe impairment of renal function (p = 0.06) whereas CCG was not significantly biased only in patients between 40 and 59 years (p = 0.6) and with eGFR 45-59 ml/min/1.73m2 (p = 0.32) or ≥ 60 ml/min/1.73m2 (p = 0.48). CONCLUSIONS: In general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.


Assuntos
Ponte de Artéria Coronária/mortalidade , Taxa de Filtração Glomerular/fisiologia , Complicações Pós-Operatórias/mortalidade , Insuficiência Renal Crônica/mortalidade , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/cirurgia , Estudos Retrospectivos
19.
Ann Intern Med ; 171(9): 659-664, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31590185

RESUMO

This article discusses potential indications for genetic testing in an African American patient with chronic kidney disease who is being evaluated for a kidney transplant. Two known risk variants in the APOL1 (apolipoprotein L1) gene predispose to kidney disease and are found almost exclusively in persons of African ancestry. APOL1 risk variants are considered, including whether clinicians should incorporate genetic testing in the screening process for living kidney donors. In addition to APOL1 testing, the role of diagnostic exome sequencing in evaluating potential transplant recipients and donors with a positive family history of kidney disease is discussed.


Assuntos
Apolipoproteína L1/genética , Testes Genéticos , Transplante de Rim , Medicina de Precisão/métodos , Insuficiência Renal Crônica/genética , Afro-Americanos/genética , Testes Genéticos/métodos , Humanos , Transplante de Rim/métodos , Insuficiência Renal Crônica/cirurgia , Doadores de Tecidos
20.
Ann Transplant ; 24: 569-575, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31591375

RESUMO

BACKGROUND Kidney transplantation (KTx) reverses most abnormalities related to chronic kidney disease (CKD), but sedentary lifestyle persists in most kidney graft recipients. Physical inactivity has been associated with altered adipokine profile and inflammation in CKD. We postulated that increased physical activity achieved through an individually-tailored program can reverse these changes. MATERIAL AND METHODS We included 25 clinically stable KTx recipients at least 12 months after transplantation and with eGFR >30 mL/min and 15 age-matched non-dialysis patients with CKD stage 3. Body composition, pattern of daily physical activity, and serum concentrations of leptin, adiponectin, NT-proBNP, and hsCRP were assessed at baseline. All patients in both groups participated in a 12-week supervised exercise program with short cell phone text reminders. All measurements were repeated after 3 months. RESULTS Active energy expenditure increased significantly during the 3 months in both the KTx and CKD patients, compared with baseline by 47% (p<0.001) and 20% (p=0.01), respectively. Time spent daily on physical activity was also increased (129±83 vs. 194±142 and 81±56 vs. 124±57 min, respectively, p<0.001). Adipose tissue mass decreased significantly in the KTx group (from 40.8±11 to 38.5±10.3 kg, p=0.01). Serum leptin decreased significantly in both KTx and CKD patients (from 11.5±7.0 to 10.0±5.6, p=0.03 and from 14.1±8.3 to 12.2±6.1 ng/mL, p=0.01, respectively). Serum adiponectin increased only in the KTx group (from 1900±953 to 2015±1133 ng/L, p=0.004). Serum CRP decreased in both groups (from 15.1±5.2 to 14.0±5.6 mg/L, p=0.01 in the KTx group and from 16.5±3.9 to 15.4±4.3 mg/L in the CKD group p=0.05). NTpro-BNP was unchanged during the study. CONCLUSIONS Increased physical activity induces beneficial effects on adipokine profile and inflammation but does not seem to affect volume overload in kidney transplant recipients and CKD patients.


Assuntos
Adipocinas/sangue , Terapia por Exercício/métodos , Mediadores da Inflamação/sangue , Transplante de Rim , Adiponectina/sangue , Adulto , Biomarcadores/sangue , Composição Corporal , Metabolismo Energético , Exercício Físico , Feminino , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Equilíbrio Hidroeletrolítico
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