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1.
Acta Cir Bras ; 34(5): e201900503, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166462

RESUMO

PURPOSE: To analyze the muscle changes with high-intensity aerobic training (HIAT) in an animal model of renal disease (RD). METHODS: Twenty one adult Wistar rats were divided into 3 groups: healthy sedentary (HS), RD sedentary (RDS), RD aerobic training (RDAT). RDS and RDAT were subjected to unilateral renal ischemia-reperfusion (10 min) and 21days after that, RDAT was subjected to 6 weeks HIAT (swimming). Serum creatinine (Cr) and muscle morphometry (cross-sectional area = CSA) of gastrocnemius were analyzed. RESULTS: Cr was higher (p = 0.0053) in RDS (0.82 ± 0.04) than in the others (RDAT 0.55 ± 0.04; HS 0.55 ± 0.04). Morphometric analysis (class interval of CSA in µm2/absolute frequency of muscle fibers in each class) indicated that 50th percentile occurred in: HS 7th class (3000.00-3499.00/515), RDS, 8th class (3500.00-3999.00/484), RDAT 5th class (2000.00-2499.00/856). CSA of largest fibers in RDS, RDAT, HS was 9953.00 µm2, 9969.00 µm2,11228.00 µm2, respectively. High frequency of fibers with lower CSA occurred in 4th, 5th, 6th and 7th class in RDA, absence of fibers into 22nd, 23rd classes (RDS and RDAT). CONCLUSION: HIAT in an animal model of RD resulted in increased the number of muscle fibers with smaller CSA.


Assuntos
Músculo Esquelético/fisiopatologia , Condicionamento Físico Animal/fisiologia , Insuficiência Renal/fisiopatologia , Animais , Peso Corporal/fisiologia , Creatinina/sangue , Modelos Animais de Doenças , Rim/irrigação sanguínea , Rim/fisiopatologia , Fibras Musculares Esqueléticas/fisiologia , Ratos Wistar , Valores de Referência , Traumatismo por Reperfusão/fisiopatologia , Reprodutibilidade dos Testes , Comportamento Sedentário , Natação/fisiologia
2.
Medicine (Baltimore) ; 98(18): e15516, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045843

RESUMO

Patients who undergo partial nephrectomy (PN) may exhibit renal function insufficiency, and a subset of these patients achieves renal function recovery. We evaluated the predictors of renal insufficiency and subsequent renal function recovery following PN. Data on 393 patients who underwent PN for solid renal tumors between March 2001 and November 2013, obtained from 6 institutions, were retrospectively reviewed. Renal insufficiency was defined as new onset of chronic kidney disease stage ≥3 postoperatively on the second of 2 consecutive tests. Renal function recovery was defined as an estimated glomerular filtration rate ≥60 ml/minute/1.73 m following renal insufficiency. Tumor complexity was stratified according to the RENAL classification system. The median (interquartile range) age, tumor size, and follow-up period were 53 (45-63) years, 2.6 (1.9-3.8) cm, and 36 (12-48) months, respectively. Tumors were of low complexity in 258/393 (65.6%) of cases. Renal insufficiency developed in 54/393 (13.5%) patients, in which age ≥60 years and preoperative creatinine ≥1.1 mg/ml were independent predictors. Tumor complexity, clamp type, and operative method were not significant prognostic factors. Among patients with newly developed renal insufficiency, 18/54 (33.3%) patients exhibited renal function recovery within a median period of 18 months, of which preoperative creatinine <1.1 mg/ml was an independent predictor. Age ≥60 years and preoperative creatinine ≥1.1 mg/ml were risk factors for renal insufficiency following PN. Patients with renal insufficiency whose preoperative creatinine was <1.1 mg/ml were likely to have renal function recovery.


Assuntos
Neoplasias Renais/cirurgia , Rim/fisiopatologia , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/etiologia , Fatores Etários , Creatinina/sangue , Feminino , Humanos , Rim/cirurgia , Neoplasias Renais/sangue , Neoplasias Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Complicações Pós-Operatórias/fisiopatologia , Período Pré-Operatório , Recuperação de Função Fisiológica , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
3.
Physiology (Bethesda) ; 34(3): 189-197, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30968755

RESUMO

A deficit or loss in the number of nephrons, the functional unit of the kidney, can induce compensatory growth and hyperfunction of remaining nephrons. An increase in single nephron glomerular filtration rate (SNGFR) aims to compensate but may be deleterious in the long term. The increase in SNGFR is determined by the dynamics of nephron loss, total remaining GFR, the body's excretory demand, and the functional capacity to sustain single nephron hyperfunction.


Assuntos
Adaptação Fisiológica , Néfrons/fisiopatologia , Insuficiência Renal/fisiopatologia , Animais , Taxa de Filtração Glomerular , Homeostase , Humanos
4.
Postgrad Med ; 131(4): 287-294, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30892125

RESUMO

Objectives: Recent studies have identified triglyceride-glucose index (TyG) as a surrogate of insulin resistance. Since insulin resistance correlates with renal damage, our study aims to investigate the impact of TyG on the risk of reduced eGFR and explore its value to improve the risk stratification and prevention of reduced eGFR. Methods: This cross-sectional study included 6466 participants (mean age:59.57 years, 60.2% females) from rural areas of northeast China between September 2017 to May 2018. TyG was calculated as ln[fasting triglyceride (mg/dL)×fasting plasma glucose (mg/dL)/2]. Reduced eGFR was defined as eGFR<60ml/min per 1.73m2. Results: The prevalence of reduced eGFR was 2.94%. After full adjustment, each SD increase of TyG caused 42.6% additional risk for reduced eGFR. When dividing TyG into quartiles, the top quartile had a 1.934 times risk than the bottom quartile. Furthermore, the risk of reduced eGFR increased linearly with the increment of TyG. Subgroup analysis also revealed the association was robust to several risk factors of renal damage. Finally, category-free net reclassification index (0.204, 95% CI: 0.060-0.349, p = 0.005) and integrated discrimination index (0.010, 95% CI: 0.005-0.016, p < 0.001) demonstrated the value of TyG to refine the risk stratification of reduced eGFR. Conclusion: Our work reveals the robust association between TyG and reduced eGFR. Moreover, the present study implicates the potential role of TyG as a risk indicator to optimize the prevention of reduced eGFR. Lastly, the findings also suggest the importance of simultaneous glycemic and lipid control to avoid the development and progression of reduced eGFR.


Assuntos
Glicemia/análise , Taxa de Filtração Glomerular/fisiologia , Triglicerídeos/sangue , Idoso , Biomarcadores , Índice de Massa Corporal , China , Estudos Transversais , Feminino , Humanos , Resistência à Insulina/fisiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/fisiopatologia , Fatores de Risco , Sensibilidade e Especificidade
5.
Int J Mol Med ; 43(4): 1900-1910, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30816438

RESUMO

To study the effect and molecular mechanisms of amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing on the treatment methods of renal failure and hypertension. A total of 60 cases of renal failure hypertension were randomly divided into the Control group and the Treatment group. The control group was treated with amlodipine besylate, while the treatment group was treated with amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing. A rat model of renal failure hypertension was established. Rats were divided into the sham group, model group, NC group (treated with amlodipine besylate) and treatment group (treated with amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing). Rats were given drugs at 10­20 weeks of age to observe their general condition and detect changes of blood pressure, blood biochemical indices and urine index. The pathological changes of renal tissue were examined by hematoxylin and eosin staining, and the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)9 were detected by immunohistochemistry. Reverse transcription­quantitative polymerase chain reaction was used to determine mRNA expression of phosphoinositide 3­kinase (PI3K), protein kinase B (AKT) and endothelin (ET)­1 and western blotting was used to detect the expression of phosphorylated (p)­PI3K/PI3K, p­AKT/AKT and p­nuclear factor (NF)­κB p65/NF­κB p65 protein. Systolic and diastolic blood pressures in Treated group patients were significantly lower compared with in Control group patients. The systolic and diastolic blood pressure of rats were significantly decreased and blood urea nitrogen (BUN), carbapenem­resistant Enterobacteriaceae (CRE), N­acetyl­ß­D­glucosaminidase (NAG), urine protein (UP) and blood urea protein (BUP), contents were significantly decreased following amlodipine besylate treatment. The expression of VEGF and matrix metallopeptidase 9 protein were significantly decreased, but the expression of PI3K, AKT mRNA and p­PI3K/PI3K, p­AKT/AKT protein were significantly increased. ET­1 mRNA and p­NF­κB p65/NF­κB protein were significantly increased. The pathological alterations of renal tissue were improved and the pathological changes of glomerulus, tubule and interstitium were alleviated. Amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing can effectively reduce the systolic pressure and diastolic pressure of patients, and improve the symptoms and signs of patients, which may be associated with the regulation of the expression of PI3K/AKT pathway, so as to regulate the expression of BUN, CRE, UP, BUP and NAG.


Assuntos
Pontos de Acupuntura , Anlodipino/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Medicina Tradicional Chinesa , Insuficiência Renal/complicações , Insuficiência Renal/tratamento farmacológico , Transdução de Sinais , Anlodipino/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Rim/efeitos dos fármacos , Rim/patologia , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Endogâmicos SHR , Insuficiência Renal/sangue , Insuficiência Renal/fisiopatologia , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/metabolismo
6.
Transplant Proc ; 51(5): 1571-1574, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30833028

RESUMO

In the face of access failure for renal replacement therapy or severe complications despite or due to dialysis, high-urgency renal transplant (HU-RT) allocation is possible. Vascular access failure patients have multiple comorbidities and a higher risk of cardiovascular and thrombotic events. Thus, it is presumed that graft and patient survivals might be worse for these patients. The aim of this paper was to analyze the characteristics and outcomes of HU-RT patients due to access failure for renal replacement therapy when comparing them to a population of deceased-donor renal transplant (DDRT) patients. We analyzed data from our Renal Transplantation Unit from January 2006 to April 2017. In this period, 374 patients had a renal transplant. Of these, 11 patients received a high-urgency deceased-donor renal transplant (HU-DDRT). Compared with patients who had a DDRT, HU-DDRT patients were predominantly female (54.5% vs 43.5%, P = .007) and younger (41.6 ± 7.9 vs 49.4 ± 11.8, P = .031). HU-DDRT patients were not significantly more sensitized than DDRT (14.1 ± 27.4 vs 13.5 ± 24.1, P = .935), and had a comparable number of HLA mismatches (3.4 ± 1.4 vs 3.6 ± 1.2, P = .343). Despite the higher incidence in hypertensive (90.9 vs 73.5%, P = .196) and diabetic patients (27.3% vs 15.7%, P = .305) in the HU-DDRT group, this difference was not statistically significant. The percentage of retransplantation was similar in both groups (9.1% vs 7.2%, P = .808). Donor sex, age, and baseline serum creatinine were similar between the groups. There was an increased proportion of expanded criteria donors in HU-DDRT (54.5% vs 25.1%, P = .028). There were no differences in cold or warm ischemia time nor in serum creatinine at discharge or during the first 2 years of follow-up. In both groups, a similar proportion of patients experienced acute rejection episodes. Comparable to DDRT patients, HU-DDRT patients had a high proportion of graft survival at the 1-year follow-up (90.9% vs 93.1%, P = .777). At a 2-year follow-up, graft survival was lower in the HU-DDRT group (81.8% vs 91.5%, P = .267). Mean follow-up for both groups was comparable (78.5 ± 46.7 vs 68.4 ± 40.8 months, P = .424). Overall, graft loss occurred in approximately 36.4% of HU-DDRT patients and 20.9% of DDRT patients (P = .219). Both groups had an overall mortality rate of around 9%. The differences were not statistically significant due to the limited number of patients. More comorbidities and reportedly worse cardiovascular prognosis of access failure (AF) patients and use of expanded criteria donors did not negatively reflect in worse short-term outcomes in our cohort, which highlights the importance of HU-RT in prolonging the survival of AF patients.


Assuntos
Transplante de Rim/métodos , Diálise Renal/instrumentação , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Dispositivos de Acesso Vascular/efeitos adversos , Adulto , Comorbidade , Falha de Equipamento , Feminino , Humanos , Incidência , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos , Resultado do Tratamento
7.
Med Sci Monit ; 25: 1061-1070, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30733429

RESUMO

BACKGROUND Dietary potassium has negative outcomes in patients with mildly impaired kidney function, while having positive outcomes in patients with hypertension. The association of dietary potassium intake with chronic kidney disease (CKD) development, with presence of hypertension, was studied in the Korean rural population with mildly impaired kidney function. MATERIAL AND METHODS From 3 rural areas of Korea, 5064 participants age ≥40 with CKD stage 2 at baseline were recruited. Patients were classified according to the quartile of dietary potassium intake. Newly developed CKD, defined as estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m² at the time of follow-up, and eGFR decline, defined as eGFR decrease >15% at follow-up, were studied. The effect of dietary potassium on CKD development and eGFR decline were studied by Cox proportional hazard models. The association of potassium with blood pressures and C-reactive protein was also studied to examine the underlying mechanisms. RESULTS Compared to 8.6% in normotensives, 15.7% of hypertensives developed CKD. The hazard ratio (HR) (95% confidence interval) of CKD was lower in high potassium diet only in hypertensives, with 0.60 (0.37-0.99) in the highest quartile. The eGFR decline was also lower in patients with higher potassium diet, with 0.70 (0.50-0.98) in Q3 and 0.54 (0.34-0.85) in Q4. Potassium intake has also been shown to decrease high diastolic blood pressure development (>90 mmHg) in hypertensives at 0.45 (0.25-0.83). CONCLUSIONS Dietary potassium was associated with lower risk of CKD development and eGFR decline, and this association was observed only in hypertensives.


Assuntos
Potássio na Dieta/metabolismo , Potássio na Dieta/uso terapêutico , Insuficiência Renal Crônica/etiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Estudos de Coortes , Progressão da Doença , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Rim/fisiopatologia , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Potássio/metabolismo , Modelos de Riscos Proporcionais , Estudos Prospectivos , Insuficiência Renal/fisiopatologia , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , República da Coreia , Fatores de Risco , População Rural
9.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796071

RESUMO

A 43-year-old woman who was diagnosed with the cryopyrine-associated periodic syndrome (CAPS) with severe renal failure and heart failure due to amyloid accumulation was examined by swept source optical cohernce tomography (OCT) (SS-OCT; DRI-OCT, Topcon, Tokyo, Japan) and optical coherence tomography angiography (OCTA) (RTVue XR Avanti, Optovue, Fremont, CA). Her best-corrected visual acuity was 20/40 OD and 20/25 OS. A hyporeflective band of about 100 µm thickness was seen just inferior to the retinal pigment epithelium in the cross-sectional SS-OCT images, but the deeper choroidal structures were clearly visible. In the OCTA images, the density of the retinal capillaries in the superficial and deep capillary plexus slabs were reduced, and no signals of the choroidal capillary slab was detected after removing the projection artefacts. The accumulation of amyloid can cause a reduction of both the retinal and choroidal capillary circulations although the circulation in the larger vessels are preserved.


Assuntos
Amiloidose/fisiopatologia , Corioide/irrigação sanguínea , Síndromes Periódicas Associadas à Criopirina/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto , Corioide/diagnóstico por imagem , Corioide/patologia , Síndromes Periódicas Associadas à Criopirina/complicações , Feminino , Angiofluoresceinografia , Insuficiência Cardíaca/fisiopatologia , Humanos , Insuficiência Renal/fisiopatologia , Vasos Retinianos/patologia , Resultado do Tratamento
10.
PLoS One ; 14(1): e0210106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30653509

RESUMO

BACKGROUND: Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) significantly reduces the risk of HIV acquisition. TDF is a known nephrotoxin however, renal dysfunction from TDF is mostly reversible following discontinuation. AIMS: To describe the renal function, risk factors for renal disease and associated clinical testing practices in a cohort of PrEP patients. METHODS: A retrospective review was conducted of all PrEP patients commenced on TDF/FTC at an inner metropolitan sexual health clinic in Sydney, Australia between April 2016 and July 2017, with follow-up data obtained at 3-monthly intervals until 18 months. RESULTS: 525 patients met inclusion criteria. Patients were almost exclusively male and median age was 34 years (IQR: 28 to 42). At baseline, 1.5% had an estimated glomerular filtration rate (eGFR) <70 mL/min/1.73m2. A small significant drop in eGFR of -2.5 mL/min/1.73m2 (p<0.05) occurred between PrEP commencement and the first follow-up period, followed by a progressive decline in eGFR of -0.38 mL/min/1.73m2 per month (95%CI: -0.57 to -0.20; p<0.001). Renal impairment (eGFR <70 mL/min/1.73m2) occurred in 6.5% of patients and persisted across consecutive follow-up periods in five (1.0%) patients. Patients aged ≥40 years had a greater risk of renal impairment than younger patients (HR 3.9, 95%CI: 1.8 to 8.4; p<0.001), despite similar rates of eGFR decline (p = 0.19). PrEP was discontinued in two patients (0.4%) due to renal function concerns. CONCLUSION: PrEP use led to an initial drop in eGFR and a more gradual progressive decline subsequently, but significant renal impairment remained uncommon up to 18 months of follow-up.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/efeitos adversos , Rim/fisiopatologia , Profilaxia Pré-Exposição/métodos , Insuficiência Renal/epidemiologia , Adulto , Fatores Etários , Fármacos Anti-HIV/administração & dosagem , Austrália/epidemiologia , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/administração & dosagem , Feminino , Seguimentos , Taxa de Filtração Glomerular/efeitos dos fármacos , Infecções por HIV/prevenção & controle , Humanos , Incidência , Rim/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
11.
Rev Soc Bras Med Trop ; 52: e20180101, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30652786

RESUMO

INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.


Assuntos
Neuroesquistossomose/complicações , Insuficiência Renal/etiologia , Bexiga Urinária Hiperativa/etiologia , Urodinâmica/fisiologia , Adulto , Idoso , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/fisiopatologia , Prevalência , Estudos Prospectivos , Insuficiência Renal/fisiopatologia , Fatores de Risco , Ureia/sangue , Bexiga Urinária Hiperativa/fisiopatologia , Adulto Jovem
12.
Clin Nephrol ; 91(3): 180-186, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30614440

RESUMO

AIMS: To investigate the clinicopathological features and outcomes of adefovir dipivoxil (ADV)-related renal impairment in Chinese patients. MATERIALS AND METHODS: Clinical, pathological, and follow-up data from 15 patients with ADV-related renal impairment were studied. Proximal renal tubular dysfunction (PRTD) was defined by the presence of at least two of the following four abnormalities: hypophosphatemia, hypouricemia, nondiabetic glucosuria, and proteinuria. RESULTS: All patients were treated for 3 - 15 (mean 6.7) years with daily ADV of 10 mg. Renal impairment manifested as PRTD (12, 80%), elevated serum creatinine (12, 80%), and hematuria (2, 13.3%). Mild to moderate tubulointerstitial injury primarily affecting the proximal tubules by light microscopy, and enlarged, dysmorphic mitochondria with loss and disorientation of cristae by electron microscope were identified in all of our cases. Four patients had pathological evidence of IgA nephropathy. The phosphorus, serum uric acid, and creatinine levels were normalized after ADV cessation in 66.7% (8/12) of affected patients, 27.3% (3/11) of affected patients, and 25% (3/12) of affected patients, respectively; proteinuria was eliminated in 7 of 13 affected patients (53.8%); and glucosuria and hematuria both disappeared in all affected patients. These abnormalities had hardly any recovery, and even aggravated with new-onset glucosuria, new-onset hematuria in 3 patients who replaced ADV with tenofovir. CONCLUSION: Nephrotoxicity developed in patients undergoing long-term ADV treatment and was partially reversible after drug cessation. Tubulointerstitial lesions and heteromorphic mitochondria were the predominant pathological changes. Patients with ADV-induced renal impairment should replace ADV with other antiviral agents other than tenofovir.
.


Assuntos
Adenina/análogos & derivados , Antivirais/efeitos adversos , Organofosfonatos/efeitos adversos , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/patologia , Adenina/efeitos adversos , Adulto , Creatinina/sangue , Feminino , Glicosúria/induzido quimicamente , Hematúria/induzido quimicamente , Hepatite B Crônica/tratamento farmacológico , Humanos , Hipofosfatemia/induzido quimicamente , Túbulos Renais Proximais/patologia , Túbulos Renais Proximais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mitocôndrias/patologia , Fósforo/sangue , Proteinúria/induzido quimicamente , Insuficiência Renal/fisiopatologia , Ácido Úrico/sangue
13.
Med Glas (Zenica) ; 16(1): 28-34, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30680982

RESUMO

Aim To assess triglyceride - to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS - RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDLC ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction.


Assuntos
Síndrome Coronariana Aguda/sangue , Lipoproteínas HDL/sangue , Insuficiência Renal/sangue , Triglicerídeos/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Biomarcadores/sangue , Glicemia/análise , Pressão Sanguínea , Proteína C-Reativa/análise , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ureia/sangue
14.
Cardiorenal Med ; 9(2): 83-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30544108

RESUMO

BACKGROUND: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. OBJECTIVE: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. METHODS: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. RESULTS: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (ß = 3.43, 95% CI = 0.635-6.23, p = 0.017), and RA:PCWP showed a trend towards significance (ß = 14.81, 95% CI = -0.096-29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. CONCLUSION: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.


Assuntos
Ecocardiografia/métodos , Taxa de Filtração Glomerular/fisiologia , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica/fisiologia , Rim/fisiopatologia , Insuficiência Renal/fisiopatologia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal/etiologia , Estudos Retrospectivos , Volume Sistólico/fisiologia , Fatores de Tempo , Função Ventricular Direita/fisiologia
15.
Magn Reson Imaging Clin N Am ; 27(1): 45-57, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466912

RESUMO

MR imaging has been optimized for the evaluation of a multitude of disease processes affecting the kidneys. A wide variety of noncontrast methods are available for the evaluation of both kidney structure and function, which are especially useful in clinical scenarios that obviate the use of intravenous contrast. Contrast-enhanced methods remain important, especially for tumor evaluation, and are used increasingly for functional analysis of quantitative biometrics, such as glomerular filtration rate and kidney blood flow.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/métodos , Insuficiência Renal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/fisiopatologia , Adulto Jovem
16.
Int J Cardiol ; 275: 53-58, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30342873

RESUMO

BACKGROUND: Worsening heart failure complicated by congestion, hypotension, and renal dysfunction is difficult to manage, increasingly common and predicts a poor outcome. Novel therapies are required to facilitate diuresis and implementation of disease-modifying interventions in preparation for hospital discharge. Accordingly, we investigated the haemodynamic and renal effects of the Reitan Catheter Pump (RCP) percutaneous support device in patients admitted with decompensated heart failure (DHF). METHODS: This was a prospective observational study of 20 patients admitted with DHF, ejection fraction < 30%, and Cardiac index (CI) < 2.1 L/min/m2 in need of inotropic/mechanical support. RESULTS: Patients underwent RCP support for a mean of 18.3 (±6.3) hours. The RCP increased CI from 1.84 L/min/m2 (±0.27), to 2.41 L/min/m2 (±0.45, p = 0.04), increased urine output (71 mL/h (±65) to 227 ml/h (±179) (p = 0.006) with a concomitant reduction in serum creatinine (188 µmol/L (±87) to 161 µmol/L (±78) (p = 0.0007). There were no clinically significant haemolysis, vascular injury, or thrombo-embolic complications. CONCLUSIONS: For patients admitted with DHF, the RCP improves cardiac index, diuresis and renal function without causing important complications.


Assuntos
Diurese/fisiologia , Taxa de Filtração Glomerular/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Rim/fisiopatologia , Insuficiência Renal/prevenção & controle , Volume Sistólico/fisiologia , Idoso , Cateterismo Cardíaco/métodos , Creatinina/sangue , Desenho de Equipamento , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Estudos Prospectivos , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Função Ventricular Esquerda/fisiologia
17.
Rev. lab. clín ; 11(4): 227-237, oct.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176922

RESUMO

La enfermedad renal es un problema de salud pública por su incidencia, prevalencia y morbimortalidad. La inflamación y fibrosis son el motor de toda alteración del daño renal, independientemente de su origen. El proceso inflamatorio y fibrótico se caracteriza por infiltración de células inflamatorias, liberación de citoquinas, activación de fibroblastos, de señales químicas y vías de señalización. Este proceso conlleva la generación de células efectoras productoras de matriz extracelular o de complejos de ataque que desemboca en el daño orgánico. Ninguna terapia ha demostrado eficacia total frente al daño inflamatorio o fibrótico. Muchos fármacos, en desarrollo experimental, ejercen su inmunomodulación a través de la regulación de la actividad de muchos tipos de células inmunes y presentan un perfil antiinflamatorio y fibrótico. El objetivo es ser conocedores de la importancia de los procesos que son capaces de provocar el proceso inflamatorio y fibrótico dado que podría tratarse de marcadores diagnósticos y dianas terapéuticas


Chronic kidney disease is a serious public health problem, due to its high incidence and prevalence, as well as its significant morbidity and mortality. Inflammation and fibrosis are the final step in renal failure. The inflammatory and fibrotic process is highlighted by infiltration by inflammatory cells, cytokine release, fibroblast accumulation, and activation of numerous chemical signals. Those processes involve the generating of immunomodulatory cells that produce an extracellular matrix and attack complex, leading to organ damage. There is no an effective therapy against fibrotic and inflammatory damage. There are different drugs that have shown to be beneficial over inflammation and fibrosis in experimental and in vitro studies. The aim is to be aware of the processes that are able to trigger fibrosis and inflammation, given that they could be used as diagnostic markers and therapeutic targets


Assuntos
Humanos , Insuficiência Renal/fisiopatologia , Inflamação/fisiopatologia , Fibrose/fisiopatologia , Mediadores da Inflamação/análise , Imunomodulação
18.
Saudi J Kidney Dis Transpl ; 29(6): 1470-1474, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30588980

RESUMO

Optimal treatment of severe hyponatremia in patients requiring dialysis is not known. Rapid correction with the use of different dialysis modalities can lead to osmotic demyelination syndrome. We described a safe correction of severe hyponatremia in a 42-year-old male patient requiring dialysis, who was treated with continuous venovenous hemofiltration using hypotonic replacement fluid which was prepared and adjusted on a daily basis.


Assuntos
Hemofiltração/métodos , Hiponatremia/terapia , Soluções Hipotônicas/administração & dosagem , Insuficiência Renal/terapia , Sódio/administração & dosagem , Adulto , Biomarcadores/sangue , Hemofiltração/efeitos adversos , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/fisiopatologia , Masculino , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Renal/fisiopatologia , Índice de Gravidade de Doença , Sódio/sangue , Resultado do Tratamento , Equilíbrio Hidroeletrolítico
20.
Congenit Heart Dis ; 13(4): 602-607, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30079627

RESUMO

PURPOSE: Elevated central venous pressure (CVP) has deleterious effects on several organ systems in patients with Fontan circulation. However, the relationship between CVP and estimated glomerular filtration rate (eGFR) has not been assessed in patients with Fontan circulation. METHODS: Patients with Fontan circulation whose hemodynamics were assessed by catheterization between 1987 and 2015 and had a serum creatinine measured within 72 hours prior to the procedure were included for analysis. Patients with primary kidney disease were excluded. Renal function was calculated by "bedside Schwartz" equation in children (< 18 years) and Modification of Diet in Renal Disease equation in adults. Renal dysfunction (RD) was defined by eGFR < 90mL/min/1.73m2 . Fontan patients with and without RD were compared based on demographics, co-morbidities, medication use, echocardiographic findings, hemodynamics assessed at time of catheterization, and laboratory testing values. RESULTS: Sixty-seven patients with Fontan circulation met inclusion criteria and 15 patients (22%) had RD; eGFR (mL/min/1.73m2 ) was 60-89in 13 (87%), 45-59in 1 (7%), and 30-45in 1 (7%). Compared to patients with eGFR equal to or greater than 90, patients with RD had higher CVP (18.0 [15.0-21.0] mm Hg vs 13.5 [12.3-16.0] mm Hg (P = 0.001), lower pulmonary blood flow 2.2 [1.9-2.6] L/min/m2 vs 2.8 [2.3-3.7] L/min/m2 , higher ventricular end-diastolic pressure 10.5 [7.0-17.3] mm Hg vs 8.0 [6.0-10.0] mm Hg (P = 0.050), were more likely to have worse atrioventricular valve regurgitation (P = 0.02) and were more likely to be African American (P = 0.009). CONCLUSIONS: In this study population, renal dysfunction in patients with Fontan circulation is associated with increased CVP and factors that affect CVP. African Americans with Fontan circulation may be at particular risk for renal dysfunction. Continued investigation of the effects of venous congestion on kidneys and other factors associated with renal dysfunction in patients with Fontan circulation is warranted.


Assuntos
Pressão Venosa Central/fisiologia , Creatinina/metabolismo , Taxa de Filtração Glomerular/fisiologia , Cardiopatias Congênitas/fisiopatologia , Insuficiência Renal/etiologia , Adolescente , Adulto , Criança , Ecocardiografia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Humanos , Incidência , Masculino , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
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