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1.
Nursing ; 50(1): 24-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31764581

RESUMO

Preeclampsia is a hypertensive disorder of pregnancy defined as new-onset hypertension that develops during pregnancy and resolves after delivery. Using a case history as an illustration, this article discusses hypertensive disorders of pregnancy with a focus on preeclampsia and its renal implications.


Assuntos
Pré-Eclâmpsia/enfermagem , Pré-Eclâmpsia/fisiopatologia , Insuficiência Renal Crônica/etiologia , Adulto , Feminino , Humanos , Avaliação em Enfermagem , Gravidez , Fatores de Risco
2.
Vet Parasitol ; 277: 109015, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31874403

RESUMO

Canine leishmaniosis (CanL)-associated chronic kidney disease is a leading cause of morbidity and mortality in Mediterranean countries. Novel renal biomarkers, such as serum symmetric dimethylarginine (sSDMA), may be useful surrogates for the detection of renal functional impairment. The objectives of this study were to investigate sSDMA concentrations in dogs with CanL, with and without azotemia, and to establish any potential association with the prevalence and severity of proteinuria, with the prevalence of decreased urine specific gravity and with the LeishVet clinical stages of CanL. Serum samples from 68 dogs with CanL (50 nonazotemic and 18 azotemic) and 17 healthy dogs were retrospectively examined. Increased sSDMA was documented in 26 % of dogs with CanL without azotemia and in 83.3 % of dogs with azotemia. Serum SDMA was significantly higher in azotemic compared to nonazotemic dogs and was associated with the presence and severity of proteinuria, the decreased urine specific gravity and the advanced clinical stages of CanL. The results of the present study indicate that sSDMA may be a useful adjunct to serum creatinine and urine protein/creatinine ratio for the detection of CanL-associated nephropathy, but it is of limited value for distinguishing among the LeishVet clinical stages of CanL.


Assuntos
Arginina/análogos & derivados , Doenças do Cão/diagnóstico , Leishmaniose Visceral/complicações , Leishmaniose Visceral/diagnóstico , Insuficiência Renal Crônica/etiologia , Animais , Arginina/sangue , Azotemia/veterinária , Biomarcadores/sangue , Doenças do Cão/sangue , Cães , Leishmania infantum/fisiologia , Insuficiência Renal Crônica/sangue , Estudos Retrospectivos
3.
Nat Med ; 25(12): 1822-1832, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806905

RESUMO

Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI.


Assuntos
Doença Crônica/epidemiologia , Inflamação/fisiopatologia , Longevidade/genética , Doenças Autoimunes/etiologia , Doenças Autoimunes/fisiopatologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus/etiologia , Diabetes Mellitus/fisiopatologia , Humanos , Inflamação/complicações , Inflamação/epidemiologia , Estilo de Vida , Longevidade/fisiologia , Neoplasias/etiologia , Neoplasias/fisiopatologia , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco
4.
Expert Opin Drug Saf ; 18(11): 1043-1053, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31498687

RESUMO

Introduction: Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs worldwide. However, concerns are growing about the serious adverse events and mortality linked to their long-term use. Areas covered: The authors review the main approved clinical indications and adverse events associated with PPIs, including, among others, pneumonia, Clostridium difficile infection, cardiovascular diseases, bone fractures, kidney diseases, and several nutrient deficiencies. Recent studies have reported that patients taking PPIs displayed increased mortality, linked to cardiovascular diseases, gastrointestinal malignancies, and chronic kidney diseases. Expert opinion: PPIs represent an important advance in the medical treatment of acid-related diseases. PPIs have contributed to profound reductions in hospitalizations and mortality due to upper GI complications. However, concern is growing about the wide range of potentially serious adverse events and mortality linked to chronic PPI use. Nevertheless, the level of evidence on adverse events is low; it is based on observational studies, and most findings have not been confirmed in the limited number of clinical trials available. PPI overuse and off-label prescriptions must be eradicated, but long-term PPI use for clear indications must continue, until we have stronger evidence to support claims of serious adverse events and mortality.


Assuntos
Uso Off-Label/estatística & dados numéricos , Uso Excessivo de Medicamentos Prescritos/prevenção & controle , Inibidores da Bomba de Prótons/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/etiologia , Neoplasias Gastrointestinais/mortalidade , Humanos , Inibidores da Bomba de Prótons/administração & dosagem , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/mortalidade
5.
Transplant Proc ; 51(8): 2533-2538, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471015

RESUMO

Kidney transplants from living donors have increased, but few studies have examined the long-term risks of live donor nephrectomy. This is the first study to report the blood pressure (BP) changes associated with cardiovascular disease and linked to chronic kidney disease (CKD) 1 year after live donor nephrectomy. This study examined a prospective cohort of patients who underwent donor nephrectomy between March 1, 2006, and December 31, 2016, at the Severance Hospital, Seoul, South Korea. CKD was defined as a glomerular filtration rate (GFR) of < 60 mL/min/1.73m2. Patients with a history of hypertension or CKD or an estimated GFR < 60 mL/min/1.73m2 were excluded; those examined after 1 year post-nephrectomy were included in the study population. Among 420 patients who underwent donor nephrectomy, 137 (32.6%) developed a first-time onset of a GFR < 60 mL/min/1.73m2 by the first year after surgery. After propensity score-matching the age, systolic BP (P < .001) and pulse pressure (P = .006) were significantly associated with the groups with newly developed CKD. Systolic BP and pulse pressure decreased significantly at 1 year after donor nephrectomy. These differences decreased after donor nephrectomy, possibly lowering the risk of cardiovascular disease.


Assuntos
Pressão Sanguínea , Transplante de Rim , Doadores Vivos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Doenças Cardiovasculares/etiologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Pontuação de Propensão , Estudos Prospectivos , Insuficiência Renal Crônica/etiologia , República da Coreia
6.
Diabetes Metab Syndr ; 13(4): 2653-2659, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405690

RESUMO

BACKGROUND: Metabolic syndrome (MS) increases the risk of heart disease, stroke, and other complications. AIM: The aim of this study was to assess the clinical and biochemical parameters of MS and its complications (cerebrovascular accidents, cardiovascular accidents, DN or chronic kidney disease (CKD) compared with healthy controls especially among the younger population in Northern India. MATERIAL AND METHODS: A total of 245 (healthy, MS and it's complicated) aged 18-70 years participated in the Open-Label, Single Centered; hospital-based random selection case-control comparative study. All anthropometric and biochemical assessment was done after proper consent. The metabolic syndrome was determined by IDF criteria. RESULTS: The key risk parameters in three groups i.e. Control, Metabolic syndrome, and Complicated was TG (96.5 ±â€¯46.9, 194.1 ±â€¯87.8, 148.0 ±â€¯102.2). LDL (91.2 ±â€¯27.2, 114.0 ±â€¯31.8, 69.1 ±â€¯42.5, BP (120.1 ±â€¯9.9, 139.3 ±â€¯13.3, 132.1 ±â€¯15.0) and high fasting glucose (81.1 ±â€¯13.7, 164.5 ±â€¯84.3, 138.0 ±â€¯74.5). The hs-CRP is also significantly increased in the complicated group. The subanalysis of data also indicates that younger middle age (36-55 years) group both male and female is obese, hypertensive, diabetic with lipid abnormality according to IDF criteria. CONCLUSION: The risk factors like high TG, low HDL, high BP, and high fasting glucose were found higher particularly in younger population which may lead to diagnosis & complications of diabetes, hypertension and lipid abnormality. Due to changing physiology in young and middle age population these individuals are moving towards metabolic syndrome easily and needs frequent monitoring, preventive checkups, and lifestyle changes to prevent complications.


Assuntos
Biomarcadores/análise , Doenças Cardiovasculares/etiologia , Transtornos Cerebrovasculares/etiologia , Diabetes Mellitus/etiologia , Síndrome Metabólica/complicações , Insuficiência Renal Crônica/etiologia , Adolescente , Adulto , Idoso , Antropometria , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/patologia , Estudos de Casos e Controles , Transtornos Cerebrovasculares/metabolismo , Transtornos Cerebrovasculares/patologia , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patologia , Feminino , Seguimentos , Humanos , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/patologia , Adulto Jovem
7.
Diabetes Metab Syndr ; 13(4): 2661-2665, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405691

RESUMO

AIM: diabetic patients are required for continuous monitoring programs hence continuous assessment of kidney function parameters is crucial. So, we aimed to determine the prevalence of Chronic Kidney Disease (CKD) and abnormal renal parameters, with poorly controlled type 2 diabetes mellitus pateints MATERIALS AND METHODS: A cross-sectional study was carried out at private health care centre. A total of 300 diabetic patients aged 18 years and above attended the clinic from February 2018 to Dec 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23). RESULTS: out of the 300 diabetes patients recruited 42% of patients with type 2 diabetes had abnormal Creatinine Serum levels and 22.3% had abnormal glomerular filtration rate (GFR). Abnormal albumin urine levels were found in 28.3% and 11.3% had abnormal creatinine in urine. Abnormal Albumin: Creatinine Ratios (Alb/Cr), were found in 23%. Of the total, 77% (n = 231) had normal Alb: Cr Ratio, 20% had risk of nephropathy and 9% had nephropathy. CONCLUSION: Current study revealed a high prevalence of abnormal renal parameters in patients with type 2 diabetes Mellitus. This necessitates the need for early and universal screening of renal functions. There is also an urgent demand for measures that target tight glycaemic, Vitamin D level and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Glicemia/análise , Estudos Transversais , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/patologia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/patologia , Fatores de Risco , Emirados Árabes Unidos/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-31370256

RESUMO

Chronic kidney disease of unknown etiology (CKDu) is a global epidemic. Sri Lanka has experienced a doubling of the disease every 4 or 5 years since it was first identified in the North Central province in the mid-1990s. The disease primarily affects people in agricultural regions who are missing the commonly known risk factors for CKD. Sri Lanka is not alone: health workers have reported prevalence of CKDu in Mexico, Nicaragua, El Salvador, and the state of Andhra Pradesh in India. A global search for the cause of CKDu has not identified a single factor, but rather many factors that may contribute to the etiology of the disease. Some of these factors include heat stroke leading to dehydration, toxic metals such as cadmium and arsenic, fluoride, low selenium, toxigenic cyanobacteria, nutritionally deficient diet and mycotoxins from mold exposure. Furthermore, exposure to agrichemicals, particularly glyphosate and paraquat, are likely compounding factors, and may be the primary factors. Here, we argue that glyphosate in particular is working synergistically with most of the other factors to increase toxic effects. We propose, further, that glyphosate causes insidious harm through its action as an amino acid analogue of glycine, and that this interferes with natural protective mechanisms against other exposures. Glyphosate's synergistic health effects in combination with exposure to other pollutants, in particular paraquat, and physical labor in the ubiquitous high temperatures of lowland tropical regions, could result in renal damage consistent with CKDu in Sri Lanka.


Assuntos
Doenças dos Trabalhadores Agrícolas/etiologia , Glicina/análogos & derivados , Herbicidas/toxicidade , Exposição Ocupacional/efeitos adversos , Insuficiência Renal Crônica/etiologia , Doenças dos Trabalhadores Agrícolas/epidemiologia , Desidratação/complicações , Glicina/toxicidade , Transtornos de Estresse por Calor/complicações , Humanos , Paraquat/toxicidade , Prevalência , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Sri Lanka/epidemiologia
9.
Expert Rev Clin Pharmacol ; 12(9): 867-874, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456441

RESUMO

Introduction: Hepatitis B virus is an important cause of liver disease and has numerous extra-hepatic manifestations. HBV leads to important morbidity and mortality in the general population and recent evidence suggests a role of HBV in the incidence and progression of chronic kidney disease. Areas covered: The mechanisms underlying the link between HBV and CKD remain unclear. Nucleos(t)ide analogues for the antiviral treatment of HBV are currently available; these drugs are provided with high efficacy even in patients with CKD. Expert opinion: A recent meta-analysis of clinical studies showed that HBV results in a greater risk of CKD in the general population. According to an updated review (studies were identified from PubMed, EMBASE, and the Cochrane database), we retrieved six clinical studies (n = 1,034,773 unique patients), adjusted RR, 1.41 (95% CI, 1.09; 1.82, P < 0.001). The significant heterogeneity observed precluded more definitive conclusions. Various mechanisms have been cited to explain the greater risk of CKD among HBsAg positive carriers. Novel evidence shows that untreated HBV and therapy with nucleos(t)ide analogues are associated with increased and decreased risk of end-stage renal disease in CKD population, respectively. We recommend that patients with HBV are assessed for kidney function and urinary changes at baseline and over the follow-up.


Assuntos
Antivirais/administração & dosagem , Hepatite B/complicações , Insuficiência Renal Crônica/etiologia , Progressão da Doença , Hepatite B/tratamento farmacológico , Hepatite B/virologia , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Falência Renal Crônica/virologia , Testes de Função Renal , Nucleosídeos/administração & dosagem , Nucleotídeos/administração & dosagem , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/virologia , Fatores de Risco
10.
Transplant Proc ; 51(8): 2539-2542, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447190

RESUMO

PURPOSE: We aim to see the rate of progression to chronic kidney disease stage III after living donor nephrectomy in a single institution annually. METHODS: Between May 2006 and July 2017, a total of 753 living kidney donors who were followed up more than 6 months were enrolled in the study. We divided normal function vs chronic kidney disease III at 6 months postoperatively. We compared the incidence rate of chronic kidney disease stage III annually. For analysis, the entire period was divided into Era 1 (2006-2008), Era 2 (2009-2011), Era 3 (2012-2014), and Era 4 (2015-2017). RESULTS: During the period, the incidence of chronic kidney disease stage III was 258 living donors (34.3%). The prevalence of chronic kidney disease stage III was 39.3%, 36.6%, 35.5%, and 29.3% in Era 1, Era 2, Era 3, and Era 4, respectively. The rate of chronic kidney disease stage III incidence serially decreased as the era passed (P = .046). There was no difference in age, smoking status, drinking status, body mass index, preoperative cholesterol, and uric acid among the eras. However, preoperative estimated glomerular filtration rate was 90.86 (SD, 4.12), 94.47 (SD, 16.62), 103.82 (SD, 0.68), and 105.66 (SD, 19.57) mL/min/1.73 m2 in Era 1, Era 2, Era 3, and Era 4, respectively (P = .001). CONCLUSIONS: The incidence of chronic kidney disease stage III in living kidney donors for the last 3 years (Era 4) has decreased compared with the past (Era 1 and 2). The reason for this might be the effect of the change in the living donor guideline. Also, pre- and postoperative management method had an effect on renal function at 6 months.


Assuntos
Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Rim/fisiopatologia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Prevalência , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodos
12.
J Cardiothorac Surg ; 14(1): 151, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438993

RESUMO

BACKGROUND: To study different value of estimated glomerular filtration rate with normal serum creatinine whether is a risk factor for hidden renal function of cardiac surgery outcomes. METHODS: A total of 1744 cardiac surgery patients with serum creatinine ≤1.2 mg/dL (female)/1.5 mg/dL (male) were divided into 3 groups: estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2 (no renal dysfunction, n = 829), 60 ≤ estimated glomerular filtration rate < 90 mL/min/1.73 m2 (hidden renal dysfunction, n = 857), estimated glomerular filtration rate < 60 mL/min/1.73 m2 (known renal dysfunction, n = 58) and followed up for 3 years. Multivariate regression analyses for risk factors of postoperative acute kidney injury. RESULTS: The proportion of preoperative hidden renal dysfunction was 67.1% among patients ≥  65 years old and 44.1% among patients < 65 years old. Multivariate Cox regression analyses showed that for patients < 65 years, known renal dysfunction was a risk factor for postoperative acute kidney injury (P <  0.01) and progressive chronic kidney disease (P = 0.018), while hidden renal dysfunction was a risk factor for progressive chronic kidney disease (P = 0.024). For patients ≥  65 years, only known renal dysfunction was a risk factors for 3-year mortality (P = 0.022) and progressive chronic kidney disease (P <  0.01). CONCLUSION: Hidden renal dysfunction was common in patients with normal serum creatinine for cardiac surgery, with a prevalence of 49.1%. For patients < 65 years old, hidden renal dysfunction was an independent risk factor for progressive chronic kidney disease.


Assuntos
Lesão Renal Aguda/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/etiologia , Lesão Renal Aguda/fisiopatologia , Adulto , Fatores Etários , Idoso , Doenças Assintomáticas , Creatinina/sangue , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
13.
Int J Mol Sci ; 20(15)2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31362427

RESUMO

Amplification of oxidative stress is present since the early stages of chronic kidney disease (CKD), holding a key position in the pathogenesis of renal failure. Induction of renal pro-oxidant enzymes with excess generation of reactive oxygen species (ROS) and accumulation of dityrosine-containing protein products produced during oxidative stress (advanced oxidation protein products-AOPPs) have been directly linked to podocyte damage, proteinuria, and the development of focal segmental glomerulosclerosis (FSGS) as well as tubulointerstitial fibrosis. Vascular oxidative stress is considered to play a critical role in CKD progression, and ROS are potential mediators of the impaired myogenic responses of afferent renal arterioles in CKD and impaired renal autoregulation. Both oxidative stress and inflammation are CKD hallmarks. Oxidative stress promotes inflammation via formation of proinflammatory oxidized lipids or AOPPs, whereas activation of nuclear factor κB transcription factor in the pro-oxidant milieu promotes the expression of proinflammatory cytokines and recruitment of proinflammatory cells. Accumulating evidence implicates oxidative stress in various clinical models of CKD, including diabetic nephropathy, IgA nephropathy, polycystic kidney disease as well as the cardiorenal syndrome. The scope of this review is to tackle the issue of oxidative stress in CKD in a holistic manner so as to provide a future framework for potential interventions.


Assuntos
Estresse Oxidativo , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/metabolismo , Albuminúria/etiologia , Albuminúria/metabolismo , Animais , Biomarcadores , Gerenciamento Clínico , Modelos Animais de Doenças , Progressão da Doença , Fibrose , Humanos , Glomérulos Renais/metabolismo , Glomérulos Renais/patologia , Microvasos/metabolismo , Microvasos/patologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia
14.
Hypertension ; 74(3): 630-638, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31327258

RESUMO

Primary aldosteronism causes renal structural damage after glomerular hyperfiltration, and primary aldosteronism-specific treatment leads to an acute fall in estimated glomerular filtration rate (eGFR). We investigated whether this change affected the long-term eGFR slope in a retrospective cohort from the multicenter Japan Primary Aldosteronism Study. We allocated patients with primary aldosteronism to the adrenalectomy (n=202) and MR (mineralocorticoid receptor) antagonist (n=303) groups based on their treatment history and analyzed the association between the initial eGFR fall and long-term eGFR slope. The increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels were independent predictors for a large initial eGFR fall in both groups. Our analysis of tertiles based on the initial eGFR fall revealed that in the MR antagonist group, patients with a small initial eGFR fall had a significantly steeper long-term eGFR slope than those with a large initial fall (tertile 1 versus 2, P=0.025; tertile 1 versus 3, P=0.017). These associations were not identified in the adrenalectomy group. Thus, the smaller the acute fall in eGFR by initiation of MR antagonists, the greater was the rate of long-term eGFR decline. While the acute fall in eGFR induced by primary aldosteronism-specific treatment is occasionally a clinical concern, our findings highlight the favorable implications of the acute fall with respect to long-term renal outcomes.


Assuntos
Adrenalectomia/métodos , Progressão da Doença , Hiperaldosteronismo/tratamento farmacológico , Hiperaldosteronismo/cirurgia , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Insuficiência Renal Crônica/etiologia , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Hiperaldosteronismo/diagnóstico , Japão , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Análise de Regressão , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Diabetes Metab Syndr ; 13(2): 1041-1046, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336441

RESUMO

BACKGROUND: Obesity-related to metabolic syndrome was associated with a greater risk for development of chronic kidney disease (CKD). We aimed to assess the association between obesity and micro/macroalbuminuria in hypertensive patients with a poor estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. METHODS: One hundred old patients (median age 79 years ±â€¯inter-quartile range 68-84.7) with manifested hypertension (systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 85 mmHg) and a permanently poor eGFR for a duration time more than 3 months were enclosed. Albuminuria was defined as urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/gr and it was classified according to KDIGO 2012. The obesity was defined by a high body mass index (BMI>30 kg/m2). The waist circumference, HDL-C, triglycerides and serum glucose were measured. Chi-square tests and an adjusted model were performed. RESULTS: Chi-square tests showed significant association between classified albuminuria and both obesity and high serum triglycerides (x2 = 7.2, p = 0.02 and x2 = 8.3, p = 0.01 respectively). However, the adjusted model for the prediction of albuminuria showed that the presence of a high BMI was a non-significant risk factor, although diabetes mellitus and eGFR value were found to be significant risk factors (p = 0.03, OR = 4.3, 1.2-22.07 and p = 0.04, OR = 0.9, 0.9-1.007 respectively) adjusting to covariates including the high waist circumference. CONCLUSION: Obesity defined by a high BMI was not found to be a significant risk factor for micro/macroalbuminuria in hypertensive patients with a poor estimated glomerular filtration rate, when diabetes mellitus and the low eGFR value act as confounders.


Assuntos
Albuminúria/etiologia , Índice de Massa Corporal , Diabetes Mellitus/etiologia , Taxa de Filtração Glomerular , Hipertensão/complicações , Obesidade/fisiopatologia , Insuficiência Renal Crônica/etiologia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/metabolismo , Albuminúria/patologia , Biomarcadores/análise , Estudos Transversais , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patologia , Feminino , Seguimentos , Humanos , Hipertensão/metabolismo , Hipertensão/patologia , Testes de Função Renal , Masculino , Prognóstico , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/patologia , Fatores de Risco , Circunferência da Cintura
16.
J Vet Intern Med ; 33(5): 1921-1925, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31305000

RESUMO

BACKGROUND: Diabetes mellitus is the main cause of chronic kidney disease (CKD) in humans. The relationship between the 2 diseases in cats is unclear. OBJECTIVE: To assess the association between diabetes and CKD in a population of adult cats. ANIMALS: Five hundred sixty-one cats that attended 2 veterinary centers in Gran Canaria, Spain, between 2014 and 2016. METHODS: Medical records were retrospectively reviewed. Cats aged 3 years or older, with sufficient data to define whether or not they had diabetes and CKD, were selected. Cats in critical condition, with dehydration or potential causes of prerenal azotemia and those treated with nephrotoxic drugs were excluded. Diagnosis of CKD was established when creatinine concentrations were >2 mg/dL, or serum creatinine 1.6-2 mg/dL and urine specific gravity <1.035, or serum creatinine 1.6-2 mg/dL and urine protein/creatinine ratio >0.4. Factors associated with CKD were identified through multivariate logistic regression analyses. RESULTS: Sixty-seven (11.9%) cats had CKD and 16 (2.9%) cats had diabetes. Sixty cats without diabetes (11%) and 7 with diabetes (44%) had CKD. Among the latter, both conditions were diagnosed simultaneously in 6 cases, whereas diabetes preceded CKD in the other. Multivariate analysis showed that diabetes was significantly associated with CKD (odds ratio = 4.47; 95% confidence interval, 1.51-13.28; P = .007). Other variables associated with CKD were age and mixed breed. CONCLUSIONS AND CLINICAL IMPORTANCE: After adjusting for age, this study showed an association between diabetes and CKD in adult cats.


Assuntos
Doenças do Gato/etiologia , Diabetes Mellitus/veterinária , Insuficiência Renal Crônica/veterinária , Animais , Gatos , Complicações do Diabetes , Feminino , Masculino , Análise Multivariada , Insuficiência Renal Crônica/etiologia , Espanha
17.
Turk J Gastroenterol ; 30(7): 611-615, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31290748

RESUMO

BACKGROUND/AIMS: This study investigated an association between obesity and impaired renal functions in elderly patients with nonalcoholic fatty liver disease (NAFLD) and evaluated the risk factors for chronic kidney disease (CKD) in these patients. MATERIALS AND METHODS: A cross-sectional study was performed involving 515 elderly patients (≥ 60 years old) with NAFLD. Demographics, body mass index (BMI), medical history, and laboratory parameters were compared for groups stratified by obesity (≥ 28 kg/m2) or CKD. An association between obesity and CKD was analyzed, and a multivariate logistic regression analysis was conducted for risk factors associated with CKD. RESULTS: In the overall population, 28.7% were obese and 54.8% had CKD; there were more women (58.8%) than men. The prevalence of hypertension and diabetes was similar between the obese and nonobese groups and between the CKD and non-CKD groups. Obese patients had significantly higher levels of serum uric acid and estimated glomerular filtration rates when compared with the nonobese group. When compared with those without CKD, patients with CKD were significantly older in addition to having higher BMI and serum uric acid levels. The multivariate logistic regression analysis indicated that CKD was positively associated with age, BMI, and serum uric acid levels. CONCLUSION: Elderly obese patients with NAFLD are at a higher risk of CKD. NAFLD patients with advanced age, greater BMI, or higher serum uric acid levels are more prone to developing CKD. The renal function of NAFLD patients should be closely monitored.


Assuntos
Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/complicações , Insuficiência Renal Crônica/etiologia , Fatores Etários , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Ácido Úrico/sangue
18.
Hypertension ; 74(3): 564-571, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31280649

RESUMO

This study investigated the association between salt intake and risk of disaster hypertension. We analyzed the data of surveys evaluating the health condition of evacuees in shelters after the Great East Japan Earthquake on April 30 and May 5, 2011. Among 272 subjects who completed the basic health condition questionnaire and underwent a medical examination, 158 (58%) had disaster hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg). Average estimated sodium intake assessed by spot urine was significantly associated with disaster hypertension (odds ratio per 1 g/d, 1.16; 95% CI, 1.05-1.30). When we defined the high risk factors for salt-sensitive hypertension as older age (≥65 years), obesity (body mass index, ≥25 kg/m2), chronic kidney disease, and diabetes mellitus, estimated sodium intake was found to be a risk factor for disaster hypertension in the total group (odds ratio per 1 g/d, 1.27; 95% CI, 1.12-1.43) and even in the group without prevalent hypertension before disaster (n=146; odds ratio per 1 g/d, 1.46; 95% CI, 1.19-1.79). There was an interaction between estimated sodium intake and disaster hypertension according to the presence or absence of high risk of salt-sensitive hypertension in the group without prevalent hypertension (P=0.03). Disaster hypertension conferred a risk of microalbuminuria (odds ratio, 3.00; 95% CI, 1.71-5.26; P<0.001). We conclude that increased estimated sodium intake was associated with disaster hypertension in evacuees after disaster. This association was noted in the population with high risk of salt-sensitive hypertension and without prevalent hypertension before natural disaster. Additionally, disaster hypertension was associated with subclinical organ damage.


Assuntos
Terremotos , Hipertensão/induzido quimicamente , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Cloreto de Sódio na Dieta/efeitos adversos , Distribuição por Idade , Idoso , Estudos Transversais , Desastres , Abrigo de Emergência , Feminino , Humanos , Hipertensão/fisiopatologia , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Potássio/metabolismo , Prevalência , Valores de Referência , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Sobreviventes/estatística & dados numéricos
19.
Arch Pediatr ; 26(5): 290-294, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31281039

RESUMO

BACKGROUND: Acute tubulointerstitial nephritis (ATIN) is a rare condition in children. The etiology, treatment, and outcome of childhood ATIN remain poorly understood. The long-term prognosis seems to be favorable; however, chronic kidney disease has been reported. This article describes clinical outcomes in a series of children with biopsy-proven ATIN. METHODS: All medical records with biopsy-proven ATIN between January 2006 and 2016 were retrospectively analyzed. The incidence, clinical features, etiology, treatment, and outcome were recorded for each patient. RESULTS: Over 10 years, ATIN was diagnosed in 25 cases (8%) based on 306 renal needle biopsies. The most frequent clinical signs were abdominal pain, asthenia/weight loss, and fever. A median glomerular filtration rate estimated at 30.1mL/min/1.73 m2 (16.5; 45.5). Drug-induced toxicity was the main etiology (eight patients). Other causes were TINU syndrome (tubulointerstitial nephritis and uveitis) (seven patients), infection (two patients), and toxic agents other than medication (one patient). No etiology was found in seven patients (idiopathic cases). Eighteen patients (72%) were treated with steroids. At the end of follow-up, eight patients presented chronic kidney disease, three hypertension, and three tubular dysfunction. Overall, renal function was highest in the idiopathic ATIN group and in children treated without delay. CONCLUSIONS: In a single-center 10-year series of biopsy-confirmed ATIN in children, drugs and TINU syndrome were the main etiologies of ATIN. This study suggests that children with idiopathic ATIN and prompt treatment have a better prognosis. In this series, occurrence of chronic kidney disease justified long-term follow-up.


Assuntos
Nefrite Intersticial/complicações , Insuficiência Renal Crônica/etiologia , Adolescente , Anti-Inflamatórios/uso terapêutico , Biópsia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/tratamento farmacológico , Nefrite Intersticial/fisiopatologia , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/patologia , Estudos Retrospectivos , Fatores de Risco , Esteroides/uso terapêutico , Resultado do Tratamento
20.
Ann Hematol ; 98(10): 2273-2281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256219

RESUMO

Although renal dysfunction at the time of diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) is a risk factor for mortality, subsequent renal events can occur. The objective of this study was to identify clinical implication of renal dysfunction occurring during the disease course in PNH patients. One hundred one patients with a granulocyte clone size of > 10% were enrolled. Renal events were observed in 55 (54.5%) patients during a median follow-up of 94.2 months. Median time to first renal event from diagnosis of PNH was 79.3 months. Thromboembolism (TE) event and recurrent TE events were observed in 25 (24.8%) and 8 (7.9%) patients, respectively. The rate of recurrent TE was significantly higher in patients with renal events ≥ 2 compared with that in patients with renal event ≤ 1 (18.8% vs. 2.9%; P = 0.012). The rate of recurrent TE was significantly higher in patients with chronic kidney disease (CKD) + acute kidney disease (AKD) compared with the rest of the patients (27.3% vs. 5.6%; P = 0.040). CKD+AKD was the only independent risk factor for OS in multivariate analysis (hazard ratio 7.95, 95% CI 1.24-51.15, P = 0.029). Therefore, close monitoring of renal events in PNH patients during the entire clinical course is essential.


Assuntos
Lesão Renal Aguda , Hemoglobinúria Paroxística , Insuficiência Renal Crônica , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Seguimentos , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia
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