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1.
Ann Neurol ; 88(4): 851-854, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32613682

RESUMO

Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Although several structural brain abnormalities have been described, their impact on brain function and implications for prognosis are unknown. Functional neuroimaging, which has prognostic significance, has yet to be explored in this population. Here we describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated intact functional network connectivity, and weeks later recovered the ability to follow commands. When prognosticating for survivors of severe COVID-19, clinicians should consider that brain networks may remain functionally intact despite structural injury and prolonged unresponsiveness. ANN NEUROL 2020;88:851-854.


Assuntos
Encéfalo/diagnóstico por imagem , Coma/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Estado Vegetativo Persistente/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Recuperação de Função Fisiológica , Betacoronavirus , Encéfalo/fisiopatologia , Coma/fisiopatologia , Infecções por Coronavirus/terapia , Eletroencefalografia , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vias Neurais , Pandemias , Estado Vegetativo Persistente/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Insuficiência Renal/fisiopatologia , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Choque/fisiopatologia
2.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32554520

RESUMO

Serum creatinine is typically used to evaluate kidney function. Yet, it is a marker that can only provide estimations of kidney function because it can be influenced by other factors, such as dietary intake. The expanding field of infant formula selection in recent history has given many options for parents who are unable to provide breastmilk. Standard infant formulas and breastmilk generally fall within a select range of creatine content. With greater accessibility to internet-based medical advice (licensed or unlicensed), parents and families have more chances to be exposed to opportunistic websites and opinions that may provide harmful information. In this report, we describe the case of excessive dietary creatine intake in an infant who presented with elevated creatinine while otherwise appearing healthy and having normal cystatin C. After in-depth evaluation of nutritional intake, there was a suspicion for high creatine load of the infant's homemade formula, which was composed of beef liver and various unregulated nutritional powders. Within 12 hours of stopping the infant's homemade formula and providing intravenous fluids, the infant's creatinine normalized. We highlight the importance of in-depth nutrition assessments and education on the health risks associated with improper formula selection.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Fórmulas Infantis/efeitos adversos , Leite Humano , Insuficiência Renal/sangue , Biomarcadores/sangue , Humanos , Lactente , Masculino , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia
3.
N Z Med J ; 133(1515): 16-24, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438373

RESUMO

BACKGROUND: Little is known about the prevalence of renal impairment in patients presenting with osteoporotic fractures contraindicating bisphosphonate use in New Zealand, and their eligibility to denosumab. AIM: To assess the prevalence of renal impairment contraindicating bisphosphonate use in older adults presenting with osteoporotic fractures, differences in demographic variables between those with renal impairment and those who do not, and finally to assess eligibility for denosumab based on the current PHARMAC special authority criteria. METHOD: All patients 65 years and older with osteoporotic fractures treated by inpatient orthogeriatric service (IOS) and the outpatient fracture liaison service (FLS) at Middlemore Hospital between 1 February to 31 April 2019 were assessed. Following data was retrospectively collected-age, sex, ethnicity, preadmission residential status, type of acute osteoporotic fractures, history of previous osteoporotic fractures, cognitive impairment and its severity, history of falls, previous dual-energy x-ray absorptiometry (DEXA) scan and the worst documented T-scores over total hip, neck of femur or L1-4 spine and previous funded anti-resorptive therapy use. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault formula based on the ideal body weight according to the recorded height and serum creatinine level at the time of patient's presentation. Patients with CrCl below 35ml/min were assigned to the renal group, and those with CrCl above 35ml/min to the non-renal group. Current PHARMAC criteria for denosumab was used to assess the eligibility in the renal group. RESULTS: Total of 190 patients (102 IOS and 88 FLS) were assessed. Thirty-four patients (17.9%) had renal impairment with CrCl less than 35ml/min and were assigned to the renal group. There were no statistically significant differences in demographic variables between the renal and the non-renal group other than for age, where the renal group was significantly older (85.4 vs 77.5 years, P-value <0.0001). Two out of 34 patients were eligible for denosumab. Reasons for ineligibility to denosumab were as follows; not meeting the definition of severe established osteoporosis due to presenting with their first ever osteoporotic fracture (64.7%), no previous DEXA scans to quantify their bone mineral density (11.8%), measured bone mineral density T-score above -2.5 (5.9%); and no preceding treatment with a funded anti-resorptive therapy for at least 12 months prior to their osteoporotic fracture (11.8%). CONCLUSION: Considerable number of patients aged 65 years and older with osteoporotic fractures also had renal impairment contraindicating the use of bisphosphonates. There were no significant differences in demographic variables between the renal and non-renal group other than for age. Majority of patients in the renal group were ineligible for denosumab based on the current special authority criteria. These results highlight the need for further review and revision of the current PHARMAC criteria to improve access to denosumab in older adults with renal impairment and osteoporotic fractures.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Difosfonatos/efeitos adversos , Definição da Elegibilidade , Fraturas por Osteoporose/epidemiologia , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/efeitos adversos , Comorbidade , Contraindicações de Medicamentos , Creatinina/sangue , Feminino , Hospitais , Humanos , Masculino , Nova Zelândia/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Prevalência , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos
4.
PLoS One ; 15(4): e0230998, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251482

RESUMO

BACKGROUND: Renal failure is common in patients seeking help in medical emergency departments. Decreased renal function is associated with increased mortality in patients with heart failure or sepsis. In this study, the association between renal function (reflected by estimated glomerular filtration rate (eGFR) at the time of admission) and clinical outcome was evaluated. METHODS/OBJECTIVES: Data was used from a prospective, multi-national, observational cohort of patients treated in three medical emergency departments of tertiary care centers. The eGFR was calculated from the creatinine at the time of admission (using the Chronic Kidney Disease-Epidemiology Collaboration equation,CKD-EPI). Uni- and multivariate regression models were used for eGFR and 30-day mortality, in hospital mortality, length of stay and intensive care unit admission rate. RESULTS: 6983 patients were included. The 30-day mortality was 1.8%, 3.5%, 6.9%, 11.1%, 13.6%, and 14.2% in patients with eGFR of above 90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m2, respectively. Using multivariate regression, the adjusted odds ratio (OR) was 2.31 (for 15-29 ml/min/1.73m2, 95% confidence interval 1.36 to 3.90, p = 0.002) and 3.73 (for eGFR <15ml/min/1.73m2 as compared to >90 ml/min/1.73m2, 95% CI 2.04 to 6.84, p<0.001). For 10 ml/min/1.73m2 decrease in eGFR the OR for the 30-day mortality was 1.15 (95% CI1.09 to 1.22, p<0.001).The eGFR was also significantly associated with in-hospital mortality, the percentage of ICU-admissions, and with a longer hospital stay. No association was found with hospital readmission within 30 days. As limitations, only eGFR at admission was available and the number of patients on hemodialysis was unknown. CONCLUSION: Reduced eGFR at the time of admission is a strong and independent predictor for adverse outcome in this large population of patients admitted to medical emergency departments.


Assuntos
Taxa de Filtração Glomerular , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Creatinina/sangue , Serviço Hospitalar de Emergência , Feminino , Florida/epidemiologia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paris/epidemiologia , Estudos Prospectivos , Insuficiência Renal/sangue , Fatores de Risco , Suíça/epidemiologia , Centros de Atenção Terciária
5.
Intern Med ; 59(7): 909-916, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32238661

RESUMO

Objective A positive correlation is observed between the progression of renal impairment and the increasing risk of cardiovascular disease. Our aim was to examine the relationship between the renal resistive index (RRI) assessed by duplex sonography and the extent of atherosclerosis in patients without renal impairment undergoing vascular imaging studies. Methods The RRI was evaluated pre-procedurally among 106 outpatients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 undergoing clinically-driven coronary computed tomography angiography (CCTA). In those subjects, a carotid artery ultrasound scan was also performed to evaluate carotid artery disease. We investigated the association between the RRI and the atherosclerotic extent, defined by the presence of coronary artery calcium (CAC) >0 and carotid intima-media thickness (cIMT) ≥1.0 mm. Results Multi-site atherosclerosis (CAC>0 and cIMT≥1.0 mm) was found in 31 patients. The RRI was significantly increased with an increasing number of atherosclerotic vessels (absence of atherosclerosis: 0.65±0.04 vs. single-site atherosclerosis: 0.67±0.06 vs. multi-site atherosclerosis: 0.71±0.05, p<0.001). A multivariate logistic regression analysis showed that RRI>0.70 [odds ratio (OR): 4.05, 95% confidence interval (CI), 1.37-12.0, p=0.01], cardio ankle vascular index (CAVI) ≥9.0 (OR: 8.18, 95% CI: 2.47-27.1, p<0.01), diabetes (OR: 4.34, 95% CI: 1.37-13.7, p=0.01) and an eGFR>90 mL/min/1.73 m2 (OR: 5.89, 95% CI: 1.39-25.1, p=0.01) were associated with multi-site atherosclerosis. Conclusion The RRI, a sub-clinical renal parameter is an atherosclerotic marker in patients without renal impairment.


Assuntos
Aterosclerose/fisiopatologia , Circulação Renal/fisiologia , Insuficiência Renal/complicações , Resistência Vascular , Idoso , Aterosclerose/complicações , Velocidade do Fluxo Sanguíneo , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/fisiopatologia , Ultrassonografia Doppler
6.
Transplant Proc ; 52(4): 1202-1205, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32164959

RESUMO

BACKGROUND: Severe ischemia-reperfusion injury (SIRI) seems to be the key factor that can significantly affect the function of both native kidneys and renal allografts. Therefore, the development of a successful strategy is of a paramount importance in both basic and clinical research. METHODS: To determine the effects of SIRI on the native kidney function, a murine model was planned as follows: group 1 (n = 6) mice underwent to nephrectomy plus ischemia-reperfusion injury for 30 minutes; group 2 (n = 6) mice underwent to nephrectomy without ischemia-reperfusion injury and thus served as sham controls for SIRI. The results of serum creatinine (SCr) were analyzed using Mann-Whitney U tests to calculate the significance between mean values. Survival between groups was measured by Kaplan-Meier test. RESULTS: To reliably achieve an elevation of SCr levels animals were exposed to a SIRI. The values of SCr increased from 0.35 (SD, 0.09) mg/dL to about 2-fold within 2 days and 3-fold within the following 5 days. Under these given conditions the mice displayed signs and histologic findings of severe kidney damage. The survival rate was about 83% of the animals within a week, and they showed no capacity of complete spontaneous self-regeneration. CONCLUSIONS: In this study, we aim to establish a murine model with extensive structural kidney damage and significant elevation of SCr levels, which could be used in basic and translational research of transplantation and regenerative therapies.


Assuntos
Modelos Animais de Doenças , Transplante de Rim , Insuficiência Renal/etiologia , Traumatismo por Reperfusão/complicações , Animais , Creatinina/sangue , Rim/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia
7.
J Urol ; 204(1): 42-49, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32073996

RESUMO

PURPOSE: Loss of renal function remains a major limitation of radical nephrectomy. The extent of renal functional compensation by the preserved kidney after radical nephrectomy has not been adequately studied in this elderly population with comorbidities. MATERIALS AND METHODS: A total of 273 patients treated with radical nephrectomy without end stage renal disease with available preoperative nuclear renal scans were included in the analysis. Renal functional compensation was defined as percent change in estimated glomerular filtration rate of the preserved kidney after radical nephrectomy. Estimated glomerular filtration rate was calculated by the Chronic Kidney Disease-Epidemiology Collaboration formula up to 5 years postoperatively. Preoperative/postoperative parenchymal volumes of the preserved kidney were measured from cross-sectional imaging. Multiple regression was used to identify predictive factors for renal functional compensation. RESULTS: Median age was 67 years and 67% of the patients were male. Overall 70% had hypertension, 26% diabetes and 37% preexisting chronic kidney disease. Locally advanced (T3a or greater) tumors were found in 53% of cases. Renal functional compensation was observed at 2 weeks (median 10%) and increased during the first 3 months (median 26%) after radical nephrectomy. Functional stability was then observed to 5 years. Renal parenchymal volume increased a median of 10% at 3 to 12 months but in addition, the functional efficiency per unit of parenchymal volume also increased 8% (estimated glomerular filtration rate units/cm3 of parenchyma was 0.236 postoperatively vs 0.208 preoperatively, p=0.004). Age (-0.85, p <0.01), global preoperative estimated glomerular filtration rate (-0.28, p <0.01) and split renal function of the removed kidney (0.61, p <0.01) were independent predictors of renal functional compensation. CONCLUSIONS: Percent renal functional compensation after radical nephrectomy is greater in younger patients, when preoperative estimated glomerular filtration rate is lower and when the removed kidney has more robust function. Increases in measurable parenchymal mass and functional efficiency contribute substantially to renal functional compensation.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Rim/patologia , Rim/fisiopatologia , Nefrectomia , Complicações Pós-Operatórias , Insuficiência Renal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/fisiopatologia , Feminino , Humanos , Rim/cirurgia , Testes de Função Renal , Neoplasias Renais/patologia , Neoplasias Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Tamanho do Órgão , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Insuficiência Renal/diagnóstico , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Am J Physiol Renal Physiol ; 318(2): F518-F530, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31904283

RESUMO

Mucin-type O-linked glycosylation, a posttranslational modification affecting the stability and biophysical characteristics of proteins, requires C1GalT1 (T synthase) and its obligate, X-linked chaperone Cosmc. Hypomorphic C1GalT1 mutations cause renal failure via not yet established mechanisms. We hypothesize that impaired Cosmc-dependent O-glycosylation in podocytes is sufficient to cause disease. Podocyte-specific Cosmc knockout mice were generated and phenotyped to test this hypothesis. Female heterozygous mice displaying mosaic inactivation of Cosmc in podocytes due to random X-linked inactivation were also examined. Mice with podocyte-specific Cosmc deletion develop profound albuminuria, foot process effacement, glomerular sclerosis, progressive renal failure, and impaired survival. Glomerular transcriptome analysis reveals early changes in cell adhesion, extracellular matrix organization, and chemokine-mediated signaling pathways, coupled with podocyte loss. Expression of the O-glycoprotein podoplanin was lost, while Tn antigen, representing immature O-glycans, was most abundantly found on podocalyxin. In contrast to hemizygous male and homozygous female animals, heterozygous female mosaic animals developed only mild albuminuria, focal foot process effacement, and nonprogressive kidney disease. Ultrastructurally, Cosmc-deficient podocytes formed Tn antigen-positive foot processes interdigitating with those of normal podocytes but not with other Cosmc-deficient cells. This suggests a cell nonautonomous mechanism for mucin-type O-glycoproteins in maintaining podocyte function. In summary, our findings demonstrated an essential and likely cell nonautonomous role for mucin-type O-glycosylation for podocyte function.


Assuntos
Albuminúria/metabolismo , Chaperonas Moleculares/metabolismo , Mucinas/metabolismo , Podócitos/metabolismo , Insuficiência Renal/metabolismo , Albuminúria/genética , Albuminúria/patologia , Albuminúria/fisiopatologia , Animais , Antígenos Glicosídicos Associados a Tumores/metabolismo , Células Cultivadas , Feminino , Predisposição Genética para Doença , Glicosilação , Heterozigoto , Masculino , Glicoproteínas de Membrana/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Knockout , Chaperonas Moleculares/genética , Mosaicismo , Fenótipo , Podócitos/ultraestrutura , Insuficiência Renal/genética , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Fatores Sexuais , Sialoglicoproteínas/metabolismo
9.
Am J Cardiol ; 125(7): 1108-1114, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31982104

RESUMO

Aortic stenosis (AS) and renal dysfunction share risk factors and often occur simultaneously. The influence of renal dysfunction on the prognosis of patients with various grades of AS has not been extensively described. The present study aimed to assess the prognostic implications of renal dysfunction in a large cohort of patients with aortic sclerosis and patients with various grades of AS. Patients diagnosed with various grades of AS by transthoracic echocardiography were assessed and divided according to renal function by estimated glomerular filtration rate (eGFR). The occurrence of all-cause mortality (primary end point) and aortic valve replacement (AVR) was noted. Of 1,178 patients (mean age 70 ± 13 years, 60% male), 327 (28%) had aortic sclerosis, 86 (7%) had mild AS, 285 (24%) had moderate AS, and 480 (41%) had severe AS. Renal dysfunction (eGFR <60 ml/min/1.73 m2) was present in 440 (37%) patients, and moderate to severe AS was observed more often in these patients compared to patients without (70 vs 62%, respectively; p = 0.008). After a median follow-up of 95 [31 to 149] months, 626 (53%) patients underwent AVR and 549 (47%) patients died. Severely impaired renal function (eGFR <30 ml/min/1.73 m2) and AVR were independently associated with all-cause mortality after correcting for AS severity. In conclusion, renal dysfunction is highly prevalent in patients with various grades of AS. After correcting for AS severity and AVR, severely impaired renal function (eGFR <30 ml/min/1.73 m2) was independently associated with all-cause mortality. Independent of renal function, AVR was associated with improved survival.


Assuntos
Estenose da Valva Aórtica/complicações , Implante de Prótese de Valva Cardíaca/métodos , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/etiologia , Idoso , Estenose da Valva Aórtica/cirurgia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prognóstico , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
10.
Jpn J Clin Oncol ; 50(2): 129-137, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-31693138

RESUMO

BACKGROUNDS: S-1 plus oxaliplatin appears effective in chemo-naïve patients with advanced gastric cancer. However, comprehensive safety and efficacy data for S-1 plus oxaliplatin is limited for patients with impaired renal function. METHODS: We retrospectively extracted data from advanced gastric cancer patients with normal renal function (normal group, CLcr ≥ 60 ml/min), who were treated with standard doses of S-1 (80 mg/m2) plus oxaliplatin (100 mg/m2), and patients with impaired renal function (impaired group, CLcr < 60 ml/min) who were treated with standard or reduced doses of S-1 (60 mg/m2 or 40 mg/m2) plus standard doses of oxaliplatin. Treatment efficacy and safety between the groups were compared. RESULTS: Data from 100 normal patients and 42 patients with impaired renal function were extracted. Baseline characteristics differed significantly between the two groups, including age (median, 64 vs 72 years, P < 0.0001) and body surface area (median, 1.68 vs 1.51 m2, P < 0.0001). In the impaired group, 66.6% (28/42) started with a reduced dose. Within the impaired group, more patients had a reduced initial S-1 dose when CLcr <50 ml/min (77.3%). The median progression-free and overall survival between the normal and impaired groups was 6.1 vs 5.7 months (P = 0.698) and 16.1 vs 18.5 months (P = 0.638), respectively. CONCLUSIONS: S-1 plus oxaliplatin in advanced gastric cancer patients with impaired renal function appears safe and has demonstrated efficacy given appropriate dose modification.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Insuficiência Renal/fisiopatologia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxaliplatina/uso terapêutico , Ácido Oxônico/uso terapêutico , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/patologia , Tegafur/uso terapêutico , Resultado do Tratamento
11.
Am J Physiol Renal Physiol ; 318(1): F76-F85, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31736354

RESUMO

Renal transplant recipients (RTRs) and patients with nondialysis chronic kidney disease display elevated circulating microparticle (MP) counts, while RTRs display immunosuppression-induced infection susceptibility. The impact of aerobic exercise on circulating immune cells and MPs is unknown in RTRs. Fifteen RTRs [age: 52.8 ± 14.5 yr, estimated glomerular filtration rate (eGFR): 51.7 ± 19.8 mL·min-1·1.73 m-2 (mean ± SD)] and 16 patients with nondialysis chronic kidney disease (age: 54.8 ± 16.3 yr, eGFR: 61.9 ± 21.0 mL·min-1·1.73 m-2, acting as a uremic control group), and 16 healthy control participants (age: 52.2 ± 16.2 yr, eGFR: 85.6 ± 6.1 mL·min-1·1.73 m-2) completed 20 min of walking at 60-70% peak O2 consumption. Venous blood samples were taken preexercise, postexercise, and 1 h postexercise. Leukocytes and MPs were assessed using flow cytometry. Exercise increased classical (P = 0.001) and nonclassical (P = 0.002) monocyte subset proportions but decreased the intermediate subset (P < 0.001) in all groups. Exercise also decreased the percentage of platelet-derived MPs that expressed tissue factor in all groups (P = 0.01), although no other exercise-dependent effects were observed. The exercise-induced reduction in intermediate monocyte percentage suggests an anti-inflammatory effect, although this requires further investigation. The reduction in the percentage of tissue factor-positive platelet-derived MPs suggests reduced prothrombotic potential, although further functional assays are required. Exercise did not cause aberrant immune cell activation, suggesting its safety from an immunological standpoint (ISRCTN38935454).


Assuntos
Micropartículas Derivadas de Células/fisiologia , Exercício Físico/fisiologia , Sistema Imunitário/fisiologia , Transplante de Rim , Insuficiência Renal/cirurgia , Transplantados , Adulto , Idoso , Biomarcadores , Feminino , Citometria de Fluxo , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Período Pós-Operatório , Insuficiência Renal/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia
12.
Angiology ; 71(3): 242-248, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31829038

RESUMO

We identified changes in renal function in patients who underwent thoracic endovascular aortic repair (TEVAR) and the factors that may influence renal function. Information on 470 consecutive patients was collected. Kidney function and contrast volume were recorded. Unpaired t test, Spearman correlation, and logistic regression were used for statistical analysis. A Kaplan-Meier curve helped clarify our follow-up findings. Mean contrast volume was 90.5 ± 21.2 mL. The change in serum creatinine was significantly correlated with (1) preexisting renal pathology (P = .033) and (2) aortic dissection (AD) involving the renal arteries (P = .019). The change in serum urea nitrogen (ΔBUN) was only significantly correlated with AD involving the renal arteries (P = .0348). Contrast volume (P = .036, odds ratio = 1.010, 95% confidence interval: 1.001-1.019) was a risk factor for contrast-induced nephropathy (CIN) after TEVAR. Survival rates and renal failure rates among no CIN, CIN, and CIN-acute kidney injury groups at longest 27 months follow-up were significantly different. Creatinine and BUN were generally elevated post-TEVAR. Contrast-induced nephropathy post-TEVAR may correlate with renal comorbidities and renal artery involvement. Contrast volume is risk factor for CIN after TEVAR. More attention needs to be paid to patient renal function during follow-up.


Assuntos
Aneurisma Dissecante/mortalidade , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/mortalidade , Rim/fisiopatologia , Adulto , Idoso , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Mayo Clin Proc ; 95(1): 77-89, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31630870

RESUMO

OBJECTIVE: To investigate the pharmacodynamic properties of inclisiran, a small interfering RNA targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), in individuals with normal renal function and renal impairment (RI). PATIENTS AND METHODS: The analysis included participants with normal renal function and mild, moderate, and severe RI from the phase 1 ORION-7 renal study (n=31) and the phase 2 ORION-1 study (n=247) who received 300 mg of inclisiran sodium or placebo. RESULTS: In ORION-7, PCSK9 values were reduced at day 60 in the normal renal function group (68.1%±12.4%), mild RI group (74.2%±12.3%), moderate RI group (79.8%±4.9%), and severe RI group (67.9%±16.4%) (P<.001 vs placebo in all groups). Low-density lipoprotein cholesterol levels were significantly reduced versus placebo: normal renal function, 57.6%±10.7%; mild RI, 35.1%±13.5%; moderate RI, 53.1%±21.3%; severe RI, 49.2%±26.6% (P<.001 for all). In ORION-1, PCSK9 level reductions at day 180 were 48.3% to 58.6% in the 300-mg single-dose groups and 67.3% to 73.0% in the 300-mg 2-dose groups (P<.001 vs placebo in all groups). The corresponding low-density lipoprotein cholesterol level reductions were 35.7% to 40.2% in the 300-mg single-dose groups and 50.9% to 58.0% in the 300 mg 2-dose groups (P<.001 vs placebo in all groups). In ORION-7, exposure to inclisiran was proportionally greater in individuals with increasing RI; inclisiran was undetectable in plasma 48 hours after administration in any group. CONCLUSION: The pharmacodynamic effects and safety profile of inclisiran were similar in study participants with normal and impaired renal function. Dose adjustments of inclisiran are not required in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT02597127 and NCT03159416.


Assuntos
LDL-Colesterol/sangue , Doença da Artéria Coronariana , RNA Interferente Pequeno , Insuficiência Renal , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Hipolipemiantes/administração & dosagem , Hipolipemiantes/efeitos adversos , Hipolipemiantes/farmacocinética , Testes de Função Renal/métodos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Pró-Proteína Convertase 9/antagonistas & inibidores , RNA Interferente Pequeno/administração & dosagem , RNA Interferente Pequeno/efeitos adversos , RNA Interferente Pequeno/farmacocinética , Insuficiência Renal/diagnóstico , Insuficiência Renal/fisiopatologia , Resultado do Tratamento
14.
J Ethnopharmacol ; 248: 112354, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31689480

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Fufang Chuanxiong capsule consists of Angelica sinensis radix and Chuanxiong rhizome, which are used in the traditional Chinese medicine for the treatment of coronary artery disease, and Xinyue capsule is composed of panax quinquefolius saponin extracted from leaves and stems of Panax quinquefolium L, which has the functions of anti-myocardial ischemia, improving myocardial energy metabolism and inhibiting apoptosis of cardiomyocytes. OBJECTIVE: To observe the role of Chinese herbal medicines in the cardiovascular outcome among patients with acute coronary syndrome (ACS) and renal insufficiency after percutaneous coronary intervention (PCI). METHODS: The subjects came from the 5C trial (chictr.org number: chictr-trc-07000021), post-PCI patients suffered from ACS with mild-to-moderate renal insufficiency (30 mL•min-1•1.73 m-2 < estimated glomerular filtration rate≤89 mL•min-1•1.73 m-2) included. The study population consisted of 215 subjects in the control group who were treated with western medicine standard therapy, and 211 subjects in the treatment group who were treated with Chinese herbal medicines (Fufang Chuanxiong Capsule and Xinyue Capsule) for 6 months on the basis of western medicine standard therapy. All were followed for 1 year. The primary endpoint included the composite of cardiac death, nonfatal recurrent myocardial infarction, and ischemia-driven revascularization. Secondary endpoint included the composite of stroke, congestive heart failure, and readmission for ACS. The serum creatinine and estimated glomerular filtration rate (eGFR) were evaluated. RESULTS: After 1 year follow-up of two groups, there were 16 cases of primary endpoint in the control group and 6 cases of primary endpoint in the treatment group [absolute risk reduction (ARR): 0.046, 95%CI: 0.004-0.088; relative risk (RR): 0.38, 95%CI: 0.15-0.96, P = 0.040]. There were 15 cases of secondary endpoint in the control group and 5 cases of secondary endpoint in the treatment (ARR: 0.041, 95%CI: 0.006-0.086; RR: 0.34, 95%CI: 0.13-0.92, P = 0.033). The eGFR in the treatment group was significantly higher than that in the control group (75.19 ±â€¯16.74 mL min-1·1.73 m-2 VS 72.03 ±â€¯14.96 mL min-1·1.73 m-2, P < 0.05). The eGFR in the treatment group was significantly higher after the intervention with Chinese herbal medicines than that before intervention (72.27 ±â€¯11.83 mL min-1·1.73 m-2 VS 75.19 ±â€¯16.74 mL min-1·1.73 m-2, P < 0.05). CONCLUSION: Chinese herbal medicines plus western medicine standard therapy improved clinical outcomes in patients with ACS and mild-to-moderate renal insufficiency. Additionally, this study also demonstrated Chinese herbal medicines were useful in deferring decline of renal function.


Assuntos
Síndrome Coronariana Aguda/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Intervenção Coronária Percutânea , Insuficiência Renal/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Idoso , Causas de Morte , China , Progressão da Doença , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Recidiva , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
15.
Hematology ; 25(1): 26-33, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861969

RESUMO

Objectives: Although anemia is a widespread condition that leads to an increase in morbidity and mortality, particularly as people age, little information on anemia in centenarians is available. The objective of this study was to determine the prevalence of anemia and examine the relationship between anemia and a decline in kidney function in Chinese centenarians.Methods: We conducted a population-based cross-sectional study of a sample of 1002 Chinese centenarians (180 men and 822 women) from 2014 to 2016. Anemia was defined as a hemoglobin level of <130 g/L for men and <120 g/L for women.Results: The prevalence of anemia and severe anemia (<100 g/L) were 68.5% (men, 76.1%; women, 66.8%) and 19.6% (men, 16.1%; women, 20.3%), respectively. The risk of anemia and estimated glomerular filtration rate (eGFR) showed a nonlinear relationship (nonlinear P = 0.021). The interaction analysis revealed that ethnicity and diabetes mellitus played a role in the association between the eGFR (<60 mL/min/1.73 m2) and anemia.Conclusion: Anemia is highly prevalent in Chinese centenarians, particularly among men. Decreased kidney function was an independent determinant of anemia, especially in Han participants and participants with diabetes mellitus. The possibility of decreased kidney function needs to be considered in the evaluation and treatment of anemia in centenarians.


Assuntos
Anemia/epidemiologia , Rim/fisiopatologia , Insuficiência Renal/complicações , Fatores Etários , Idoso de 80 Anos ou mais , Anemia/fisiopatologia , China/epidemiologia , Estudos Transversais , Complicações do Diabetes/complicações , Complicações do Diabetes/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Prevalência , Insuficiência Renal/fisiopatologia , Fatores de Risco
16.
Nephrol Dial Transplant ; 34(Suppl 3): iii2-iii11, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31800080

RESUMO

There have been significant recent advances in our understanding of the mechanisms that maintain potassium homoeostasis and the clinical consequences of hyperkalemia. In this article we discuss these advances within a concise review of the pathophysiology, risk factors and consequences of hyperkalemia. We highlight aspects that are of particular relevance for clinical practice. Hyperkalemia occurs when renal potassium excretion is limited by reductions in glomerular filtration rate, tubular flow, distal sodium delivery or the expression of aldosterone-sensitive ion transporters in the distal nephron. Accordingly, the major risk factors for hyperkalemia are renal failure, diabetes mellitus, adrenal disease and the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or potassium-sparing diuretics. Hyperkalemia is associated with an increased risk of death, and this is only in part explicable by hyperkalemia-induced cardiac arrhythmia. In addition to its well-established effects on cardiac excitability, hyperkalemia could also contribute to peripheral neuropathy and cause renal tubular acidosis. Hyperkalemia-or the fear of hyperkalemia-contributes to the underprescription of potentially beneficial medications, particularly in heart failure. The newer potassium binders could play a role in attempts to minimize reduced prescribing of renin-angiotensin inhibitors and mineraolocorticoid antagonists in this context.


Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Hiperpotassemia , Potássio/sangue , Insuficiência Renal/complicações , Saúde Global , Taxa de Filtração Glomerular , Homeostase , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/epidemiologia , Hiperpotassemia/etiologia , Incidência , Insuficiência Renal/sangue , Insuficiência Renal/fisiopatologia , Fatores de Risco
17.
Medicina (B Aires) ; 79(6): 516-519, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829957

RESUMO

Tumor lysis syndrome (SLT) is a rare and potentially fatal entity. It represents an oncological emergency. It can be diagnosed by its clinical presentation and also by laboratory results. In most cases it is presented as a complication of the chemotherapeutic treatment of oncohematological diseases with large tumor mass. Less frequently, a syndrome of spontaneous tumor lysis has been described, or secondary to the use of corticosteroids, hydroxyurea and radiotherapy. In its most severe forms it may require hospitalization in intensive care units and invasive therapeutic measures such as hemodialysis. We report four cases of SLT with unusual presentation characteristics admitted to our Medical Research Institute.


Assuntos
Síndrome de Lise Tumoral/patologia , Adulto , Idoso , Antineoplásicos/efeitos adversos , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/fisiopatologia
19.
Nefrología (Madrid) ; 39(6): 646-652, nov.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189887

RESUMO

ANTECEDENTES Y OBJETIVO: Sacubitrilo/valsartán ha demostrado ser eficaz en la reducción de la morbimortalidad cardiovascular en los pacientes con disfunción sistólica. El objetivo del presente estudio fue analizar la evolución de pacientes con enfermedad renal crónica (ERC) tras el inicio de sacubitril/valsartán. MATERIAL Y MÉTODOS: Se incluyó a 66 pacientes consecutivos que acudieron a las consultas externas de Nefrología, con ERC y disfunción sistólica. Los criterios de inclusión fueron: presentar una clase funcional II a IV de la New York Heart Association (NYHA) con el tratamiento médico optimizado y ERC estadios 1 a 4. Se recogieron datos basales epidemiológicos y de comorbilidad en el momento de inicio del fármaco. En los meses 1 y 3 se tituló la dosis de sacubitril/valsartán (en función de la tolerabilidad). En cada visita se recogieron datos analíticos de función renal y biomarcadores cardiacos, entre otros. Se analizaron los datos a los 6 meses (fin del seguimiento). RESULTADOS: De los 66 pacientes, 42 eran varones (63%), con una edad media de 73 ± 15 años. La creatinina media fue de 1,42 ± 0,5 mg/dL (filtrado glomerular CKD-EPI 50 ± 19 mL/min/1,73 m2) con una fracción de eyección del ventrículo izquierdo (FEVI) media de 31 ± 9. Al final del seguimiento, la FEVI mejoró significativamente (basal 31 ± 9 vs. final 39 ± 15; p < 0,001). En cuanto a la función renal, el filtrado glomerular por CKD-EPI presentó mejoría al mes (50 ± 19 vs. 53 ± 21 mL/min/1,73 m2; p = 0,005), que se mantuvo estable (filtrado glomerular al final del seguimiento 51 ± 18mL/min/1,73 m2). Abandonaron el tratamiento 7 pacientes (10,6%). CONCLUSIÓN: En nuestra experiencia, sacubitril/valsartán es seguro en los pacientes con insuficiencia renal crónica y estabiliza la función renal a los 6 meses


BACKGROUND AND OBJECTIVES: Sacubitril/valsartan reduces cardiovascular morbidity and mortality in patients with systolic dysfunction. The aim of the present study was to assess the evolution of chronic kidney disease (CKD) patients after initiating sacubitril/valsartan. MATERIAL AND METHODS: We included 66 consecutive CKD patients with systolic dysfunction followed up in outpatient care. Patients had to meet the inclusion criteria of having a New York Heart Association class II to iv, receiving maximum tolerated doses of optimal medical therapy and CKD stages 1 to 4. At baseline, comorbidities and epidemiological data were collected and low doses of sacubitril/valsartan were initiated. At month 1 and 3, doses of sacubitril/valsartan were increased up to the maximum doses if tolerated. In each visit, renal function and cardiac biomarkers were recorded. All the data were analyzed at the end of follow up (6 months). RESULTS: Of the 66 patients, 42 (63%) were men, with a mean age of 73 ± 15 years. Mean creatinine at baseline was 1.42 ± 0.5 mg/dL (glomerular filtration rate estimated by CKD-EPI was 50 ± 19 mL/min/1.73 m2) and mean left ventricular ejection fraction (LVEF) was 31 ± 9%. At the end of follow up, LVEF improved from 31 ± 9% to 39 ± 15% (P < 0.001). After one month of treatment, renal function improved up to 53 ± 21 mL/min/1.73 m2, P = 0.005. For the remaining follow-up time, glomerular filtration rate remained stable (mean at end of follow-up 51±18 mL/min/1.73 m2). Seven patients (10.6%) withdrew from treatment. CONCLUSION: In our experience, sacubitril/valsartan is safe in CKD, offering stability in CKD progression after 6 months


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Insuficiência Renal/fisiopatologia , Tetrazóis/uso terapêutico , Valsartana/uso terapêutico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Insuficiência Cardíaca Sistólica/fisiopatologia , Insuficiência Renal/diagnóstico , Tetrazóis/efeitos adversos , Valsartana/efeitos adversos , Biomarcadores , Taxa de Filtração Glomerular , Estudos Retrospectivos , Análise de Variância
20.
J. bras. nefrol ; 41(4): 481-491, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056601

RESUMO

Abstract Introduction: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. Objective: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). Methodology: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. Results: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. Conclusion: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.


Resumo Introdução: Não se sabe ao certo se a função renal residual (FRR) de pacientes dialíticos pode atenuar o impacto metabólico do maior intervalo interdialítico (MII) de 68 horas, no qual ocorre acúmulo de volume, ácidos e eletrólitos. Objetivo: Avaliar os níveis séricos de eletrólitos, balanço hídrico e status ácido-básico de pacientes dialíticos com e sem FRR ao longo do MII. Metodologia: Tratou-se de estudo unicêntrico, transversal e analítico, que comparou pacientes com e sem FRR, definida como diurese acima de 200 mL em 24 horas. Para tal, os pacientes foram pesados e submetidos à coleta de amostras séricas para análise bioquímica e gasométrica no início e fim do MII. Resultados: Foram avaliados 27 e 24 pacientes com e sem FRR, respectivamente. Pacientes sem FRR apresentaram maior aumento de potássio sérico durante o MII (2,67 x 1,14 mEq/L, p < 0,001) atingindo valores mais elevados no fim (6,8 x 5,72 mEq/L, p < 0,001); menor valor de pH no início do intervalo (7,40 x 7,43, p = 0,018), maior proporção de pacientes com bicarbonato sérico < 18 mEq/L (50 x 14,8 %, p = 0,007) e distúrbio ácido-básico misto (70,8 x 42,3 %, p = 0,042), além de maior ganho de peso interdialítico (14,67 x 8,87 mL/kg/h, p < 0,001) e menor natremia (137 x 139 mEq/L, p = 0,02) no fim do intervalo. A calcemia e fosfatemia não foram diferentes entre os grupos. Conclusão: Pacientes com FRR apresentaram melhor controle dos níveis séricos de potássio, sódio, status ácido-básico e da volemia ao longo do MII.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Equilíbrio Hidroeletrolítico/fisiologia , Diálise Renal/efeitos adversos , Insuficiência Renal/sangue , Rim/fisiopatologia , Fosfatos/sangue , Potássio/sangue , Sódio/sangue , Desequilíbrio Ácido-Base/fisiopatologia , Bicarbonatos/sangue , Ganho de Peso , Cálcio/sangue , Estudos Transversais , Progressão da Doença , Insuficiência Renal/fisiopatologia , Insuficiência Renal/urina , Insuficiência Renal/terapia , Rim/metabolismo , Rim/química , Testes de Função Renal/métodos
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