Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.577
Filtrar
1.
Life Sci ; 242: 117239, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31901444

RESUMO

AIMS: Reactive oxygen species (ROS) and pro-inflammatory cytokines play a critical role in organ damage induced by ethanol consumption. Interleukin (IL)-10 maintain tissue homeostasis through restriction of excessive inflammatory responses and inhibition of ROS generation. These responses limit unnecessary tissue damage in the cardiorenal system. We hypothesized that IL-10 would limit the deleterious effects induced by ethanol consumption in the cardiorenal system. MATERIALS AND METHODS: Male C57BL/6J wild-type (WT) or IL10-deficient mice (IL-10-/-) were treated with ethanol (20% v/v) for 6 weeks. KEY FINDINGS: IL-10 deficiency was associated with an increased mortality rate. Ethanol consumption decreased plasma levels of IL-10 in WT mice. Increased levels of IL-6 were detected in the aorta from IL-10-deficient mice, but not WT mice. No alterations in the levels of urea, creatinine, sodium, potassium or creatine kinase (CK)-MB were found after treatment with ethanol. Augmented concentration of thiobarbituric acid reactive substances (TBARS) was found in the left ventricle (LV) of IL-10-deficient mice, but not WT mice. Increased levels of superoxide anion (O2-) were found in the renal cortex of both WT and IL-10-deficient mice. Renal cortex from WT mice chronically treated with ethanol showed decreased levels of H2O2. No changes in the expression of Nox1, Nox4 or catalase were found in the renal cortex from ethanol-treated mice. SIGNIFICANCE: IL-10 limited the production of ROS and the synthesis of pro-inflammatory cytokines induced by ethanol in the cardiorenal system. These findings provided novel evidence that IL-10 counteracted the initial mechanisms whereby ethanol induces its cardiorenal damages.


Assuntos
Etanol/efeitos adversos , Coração/efeitos dos fármacos , Interleucina-10/metabolismo , Rim/efeitos dos fármacos , Lesão Renal Aguda/induzido quimicamente , Animais , Western Blotting , Creatina Quinase Forma MB/sangue , Creatinina/sangue , Interleucina-10/sangue , Interleucina-10/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Potássio/sangue , Sódio/sangue , Ureia/sangue
2.
Life Sci ; 242: 117227, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881226

RESUMO

INTRODUCTION: Misuse of AAS is emergent among both genders, however, few studies were performed evaluating AAS effects on female body and none evaluate the impact of nandrolone decanoate (ND) in renal function. AIM: Determine the effects of chronic treatment with ND on kidney function of female rats and evaluate the influence of oxidative stress on it. MATERIAL AND METHODS: Female rats were separated into two groups (n = 8 each), the treated group (DECA), which received ND at a dose of 20 mg/kg/week (i.m), and the control group (C), which was treated with the vehicle (peanut oil, i.m.). All treatments were performed during eight weeks. After this period, 24 h urine, blood and organs (heart, gastrocnemius muscle, liver and kidney) were collected. Organ hypertrophy was calculated, and kidney collagen content was evaluated. AOPP, TBARS, SOD and catalase activity were determined in the kidney. Moreover, proteinuria and creatinine clearance were also investigated. KEY-FINDINGS: Hypertrophy was observed in the liver, gastrocnemius muscle, heart and kidney. Kidney hypertrophy was followed by a reduced organ function and an increase in collagen deposition. Oxidative stress upsurge occurred in both proteins and lipids, followed by a reduction in SOD activity. SIGNIFICANCE: Administration of DN in rats was followed by renal damage and kidney fibrosis due to increased oxidative stress on that organ.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Anabolizantes/efeitos adversos , Homeostase/efeitos dos fármacos , Decanoato de Nandrolona/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/fisiopatologia , Anabolizantes/farmacologia , Animais , Western Blotting , Catalase/metabolismo , Feminino , Rim/efeitos dos fármacos , Rim/metabolismo , Rim/patologia , Rim/fisiologia , Decanoato de Nandrolona/farmacologia , Ratos , Ratos Wistar , Superóxido Dismutase/metabolismo
3.
Toxicol Lett ; 318: 65-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654803

RESUMO

OBJECTIVE: The optimal measuring timing of serum/plasma Cystatin C (CysC) for early detection of contrast-induced acute kidney injury (CIAKI) remains un-studied. We elucidated further on this issue. METHODS: We searched PubMed, MEDLINE, and Embase from inception until March 2018 for studies evaluating diagnostic accuracy of CysC for detecting CIAKI in patients exposed to contrast agents during diagnostic examinations or cardiac/peripheral catheterizations. RESULTS: A total of 10 relevant studies, comprising 2554 patients, were included and divided into the <24 -h and 24 -h groups based on CysC measuring timing (i.e., hours after contrast agent exposure). Compared with creatinine, pooled diagnostic odds ratio of CysC for detecting CIAKI of the <24 -h and 24 -h groups was 7.59 (95 % confidence interval [CI]: 1.31-44.08) and 53.81 (95 % CI: 13.57-213.26). Pooled sensitivity of the <24 -h and 24 -h groups was 0.81 and 0.88. Pooled specificity of the <24 -h and 24 -h groups was 0.64 and 0.88, respectively. Area under the hierarchical summary receiver operating characteristic curve of the <24 -h and 24 -h groups was 0.75 and 0.93. CONCLUSIONS: Measuring CysC at 24 h after contrast agent exposure shows higher diagnostic accuracy for early detection of CIAKI than measuring CysC at <24 h after contrast agent exposure.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Cistatina C/sangue , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/sangue , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo
4.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 35(10): 897-902, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31814566

RESUMO

Objective To investigate the role of LIGHT/TNFSF14 (TNF superfamily protein 14) in cisplatin-induced acute kidney injury (Cis-AKI) in mice and explore the underlying mechanism. Methods Male wild-type (WT) and LIGHT gene knockout (LIGHT-/-) C57BL/6 mice were selected and divided into four groups: saline- and cisplatin-treated WT mice, saline- and cisplatin-treated LIGHT-/- mice. The cisplatin groups were given a single intraperitoneal injection of cisplatin (20 mg/kg, 200 µL), and the saline groups were injected with equal volume of normal saline (9 g/L). After 72 hours, the mice were sacrificed, blood was taken from the eyeball, and kidney tissues were collected. Blood urea nitrogen (BUN) and serum creatinine (Scr) were measured by automatic biochemical analyzer. HE staining was used to detect the histopathological changes of kidney tissues, The mRNA levels of LIGHT, kidney injury molecule 1 (KIM-1), interleukin-6 (IL-6), monocyte chemotactic protein 1 (MCP-1), and tumor necrosis factor (TNF-α) were detected by real-time quantitative PCR. The protein levels of LIGHT, Bcl2, BAX and cytochrome C were detected by Western blot analysis or immunohistochemical staining. Results Compared with saline-treated WT mice, the expression of LIGHT in renal tissue of cisplatin-treated WT mice significantly increased. Compared with cisplatin-treated WT mice, the kidney injury in cisplatin-treated LIGHT-/- mice was more serious; BUN and Scr increased; and the pathological damage of kidney tissue was more obvious. Moreover, the mRNA levels of IL-6, MCP-1 and TNF-α, as well as the protein levels of BAX and cytochrome C increased, while the protein levels of Bcl2 decreased. Conclusion LIGHT plays a protective role in Cis-AKI, which may be related to down-regulated secretion of inflammatory factors and decreased apoptosis.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Cisplatino/toxicidade , Membro 14 da Superfamília de Ligantes de Fatores de Necrose Tumoral/metabolismo , Animais , Apoptose , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Rim/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout
5.
Biochemistry (Mosc) ; 84(12): 1502-1512, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31870254

RESUMO

Autophagy plays an important role in the pathogenesis of acute kidney injury (AKI). Although autophagy activation was shown to be associated with an increased lifespan and beneficial effects in various pathologies, the impact of autophagy activators, particularly, rapamycin and its analogues on AKI remains obscure. In our study, we explored the effects of rapamycin treatment in in vivo and in vitro models of ischemic and cisplatin-induced AKI. The impact of rapamycin on the kidney function after renal ischemia/reperfusion (I/R) or exposure to the nephrotoxic agent cisplatin was assessed by quantifying blood urea nitrogen and serum creatinine and evaluating the content of neutrophil gelatinase-associated lipocalin, a novel biomarker of AKI. In vitro experiments were performed on the primary culture of renal tubular cells (RTCs) that were subjected to oxygen-glucose deprivation (OGD) or incubated with cisplatin under various rapamycin treatment protocols. Cell viability and proliferation were estimated by the MTT assay and real-time cell analysis using an RTCA iCELLigence system. Although rapamycin inhibited mTOR (mammalian target of rapamycin) signaling, it failed to enhance the autophagy and to ameliorate the severity of AKI caused by ischemia or cisplatin-induced nephrotoxicity. Experiments with RTCs demonstrated that rapamycin exhibited the anti-proliferative effect in primary RTCs cultures but did not protect renal cells exposed to OGD or cisplatin. Our study revealed for the first time that the mTOR inhibitor rapamycin did not prevent AKI caused by renal I/R or cisplatin-induced nephrotoxicity and, therefore, cannot be considered as an ideal mimetic of the autophagy-associated nephroprotective mechanisms (e.g., those induced by caloric restriction), as it had been suggested earlier. The protective action of such approaches like caloric restriction might not be limited to mTOR inhibition and can proceed through more complex mechanisms involving alternative autophagy-related targets. Thus, the use of rapamycin and its analogues for the treatment of various AKI forms requires further studies in order to understand potential protective or adverse effects of these compounds in different contexts.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/prevenção & controle , Antineoplásicos/efeitos adversos , Cisplatino/efeitos adversos , Isquemia/prevenção & controle , Sirolimo/farmacologia , Lesão Renal Aguda/metabolismo , Animais , Células Cultivadas , Glucose/metabolismo , Isquemia/metabolismo , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/metabolismo , Masculino , Oxigênio/metabolismo , Substâncias Protetoras/farmacologia , Ratos , Serina-Treonina Quinases TOR/metabolismo
6.
Methodist Debakey Cardiovasc J ; 15(3): 228-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687105

RESUMO

This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Ácidos Aristolóquicos/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Medicamentos de Ervas Chinesas/efeitos adversos , Falência Renal Crônica/induzido quimicamente , Rim/efeitos dos fármacos , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Progressão da Doença , Interações Ervas-Drogas , Humanos , Rim/fisiopatologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Prognóstico , Medição de Risco , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo
7.
Harefuah ; 158(11): 721-723, 2019 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-31721514

RESUMO

INTRODUCTION: Sodium metamizole (Optalgin) is one of the most prevalent analgesic and anti-pyretic medications used in Israel. We describe a case of acute kidney injury subsequent to the use of metamizole in a healthy young patient. Metamizole may cause kidney injury in a number of different mechanisms and it is vital that this fact will be emphasized due to the widespread use of this medication.


Assuntos
Lesão Renal Aguda , Anti-Inflamatórios não Esteroides , Dipirona , Lesão Renal Aguda/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Dipirona/efeitos adversos , Humanos , Israel
8.
Medicine (Baltimore) ; 98(48): e17994, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770210

RESUMO

STUDY OBJECTIVE: Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction. METHODS: This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT. RESULTS: We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ±â€Š7.66 mL·min·1.73 m and 11.56 ±â€Š5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51-25.23, P = .015) was a significant risk factor for PC-AKI. CONCLUSION: This study demonstrated that, among the echocardiographic variables, E/E was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Insuficiência Cardíaca Diastólica/complicações , Tomografia Computadorizada por Raios X/efeitos adversos , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca Diastólica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
9.
Zentralbl Chir ; 144(5): 482-487, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31634973

RESUMO

Contrast enhanced imaging was introduced over 90 years ago and has led to unprecedented triumphs in diagnostics testing, as well as in therapeutic and interventional procedures. At the same time, contrast agent exposure has been increasingly blamed for acute renal failure, particularly in hospitalised patients, and since the late 1970s. As a result, there has been a large number of studies on the toxicity of different contrast agents and on nephroprotection with various methods and substances. New studies have provided information on both the toxicity to the kidneys and the methods and substances used for nephroprotection, so that there have been clear changes in the use of contrast agents. The following article summarises recent developments in both areas and provides recommendations for the practice of using contrast-enhanced imaging, especially for kidney patients with already reduced glomerular filtration rate.


Assuntos
Lesão Renal Aguda , Meios de Contraste , Rim , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Taxa de Filtração Glomerular , Humanos , Rim/efeitos dos fármacos
10.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 35(8): 702-706, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31638567

RESUMO

Objective To analyze the changes and correlation between inflammation and Klotho expression in kidney tissue of mice with acute kidney injury (AKI) induced by cisplatin, and to explore the role and possible mechanism of Klotho in AKI induced by cisplatin. Methods Eighteen male C57BL/6 mice were randomly divided into 0-day group, 1-day group and 3-day group with 6 mice in each group. The mice were killed at 0, 1 and 3 days after a single intraperitoneal injection of 25 mg/kg of cisplatin, and the serum and kidney tissues were collected. The content of serum creatinine (Scr) and blood urea nitrogen (BUN) were measured by biochemical analyzer, and the pathological changes of kidney tissues were observed by HE staining. Neutrophil gelatinase-associated lipocalin (NGAL), tumor necrosis factor α (TNF-α), NLR family pyrin domain containing 3 (NLRP3), Klotho, signal transducer and activator of transcription 3 (STAT3), phosphorylated STAT3 (p-STAT3), nuclear factor-kappa B (NF-κB), phosphorylated NF-kappa B (p-NF-κB) were detected by Western blot analysis. Spearman rank correlation test was used to analyze the correlations. Results The content of serum Scr and BUN in 1-day and 3-day groups were significantly higher than those in 0-day group, and inflammatory cell infiltration, renal tubular epithelial cell exfoliation, edema and accumulation of cell fragments were seen in 1-day and 3-day groups. In the 3-day group, the content of NGAL, TNF-α, NLRP3, p-STAT3, STAT3, p-NF-κB and NF-κB proteins in renal tissues significantly increased, and the expression of TNF-α, p-STAT3 and STAT3 increased in a time-dependent manner. The expression of Klotho decreased in a time-dependent manner in the 1-day and 3-day groups, and the expression of NGAL, TNF-α, NLRP3, p-STAT3, and p-NF-κB were significantly negatively correlated with the expression of Klotho. Conclusion The activation of STAT3/NF-κB pathway by Klotho is involved in the regulation of the occurrence and development of AKI induced by cisplatin in mice.


Assuntos
Lesão Renal Aguda , Cisplatino , Regulação da Expressão Gênica , Glucuronidase , Rim , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/fisiopatologia , Animais , Regulação da Expressão Gênica/efeitos dos fármacos , Glucuronidase/genética , Rim/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Distribuição Aleatória
11.
Medicine (Baltimore) ; 98(43): e16989, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651833

RESUMO

Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.


Assuntos
Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Traumatismos Cardíacos/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/cirurgia , Creatinina/sangue , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco , Troponina I/sangue
12.
Medicine (Baltimore) ; 98(39): e17148, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574818

RESUMO

RATIONALE: Thrombotic microangiopathy (TMA) is a group of clinical syndromes characterized by excessive platelet activation and endothelial injury that leads to acute or chronic microvascular obliteration by intimal mucoid and fibrous thickening, with or without associated thrombi. It frequently involves the kidney but may involve any organ or system at variable frequencies depending on the underlying etiology. Among its numerous causes, drug toxicities and complement regulation abnormalities stand out as some of the most common. A more recently described association is with monoclonal gammopathy. Lung involvement by TMA is infrequent, but has been described in Cobalamin C deficiency and post stem-cell transplantation TMA. PATIENT CONCERNS: This is the case of a patient with smoldering myeloma who received proteasome-inhibitor therapy due to retinopathy and developed acute renal failure within one week of therapy initiation. DIAGNOSES: A renal biopsy showed thrombotic microangiopathy. At the time, mild pulmonary hypertension was also noted and presumed to be idiopathic. INTERVENTIONS: Given the known association of proteasome-inhibitor therapy with thrombotic microangiopathy, Bortezomib was discontinued and dialysis was initiated. OUTCOMES: Drug withdrawal failed to prevent disease progression and development of end-stage renal disease, as well as severe pulmonary hypertension that eventually lead to the patient's death. LESSONS: To our knowledge, this is the first reported case of pulmonary involvement by TMA associated with monoclonal gammopathy which appears to have been triggered by proteasome-inhibitor therapy. Clinicians should be aware of this possibility to allow for more prompt recognition of pulmonary hypertension as a potential manifestation of monoclonal gammopathy-associated TMA, especially in patients also receiving proteasome-inhibitors, so that treatment aiming to slow disease progression can be instituted.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Hipertensão Pulmonar/induzido quimicamente , Inibidores de Proteassoma/efeitos adversos , Mieloma Múltiplo Latente/tratamento farmacológico , Microangiopatias Trombóticas/induzido quimicamente , Autopsia , Biópsia , Evolução Fatal , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Pulmão/efeitos dos fármacos , Pessoa de Meia-Idade , Paraproteinemias/complicações , Mieloma Múltiplo Latente/etiologia
13.
Int Heart J ; 60(5): 1022-1029, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484858

RESUMO

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may increase contrast volume. However, the impact of OCT-guided PCI on the decline in kidney function (DKF) in actual clinical practice remains unclear.Among 1,003 consecutive patients who underwent either OCT-guided or intravascular ultrasound (IVUS)-guided PCI in our institute, we identified 202 propensity score-matched pairs adjusted by baseline factors. The incidence of DKF was compared between the OCT-guided PCI group and the IVUS-guided PCI group. DKF was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or a relative increase of ≥ 25% over baseline within 48 hours (acute DKF) or 1 month (sustained DKF) after PCI.Baseline characteristics, including the prevalence of chronic kidney disease (54% versus 46%, P = 0.09), were comparable between the OCT- and IVUS-guided PCI groups except for the age. The contrast volume was comparable between the two groups (153 ± 56 versus 144 ± 60 mL, P = 0.09), although it was significantly greater in the OCT-guided PCI group in patients with acute coronary syndrome (ACS; 175 ± 55 versus 159 ± 43 mL, P = 0.04). The incidence of acute DKF (0.5% versus 2.5%, P = 0.22) and sustained DKF (5.0% versus 10.4%, P = 0.31) was comparable between the two groups. Multivariate analysis demonstrated that ACS (odds ratio 4.74, 95% confidence interval 2.72-8.25, P < 0.001) was a predictor of sustained DKF.Compared with IVUS-guided PCI, OCT-guided PCI did not increase the incidence of DKF in actual clinical practice, although the increased contrast volume was observed in ACS cases.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Intervenção Coronária Percutânea/métodos , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Centros Médicos Acadêmicos , Síndrome Coronariana Aguda/diagnóstico por imagem , Lesão Renal Aguda/epidemiologia , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Incidência , Japão , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Razão de Chances , Segurança do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos
14.
Transplant Proc ; 51(7): 2262-2264, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400980

RESUMO

INTRODUCTION: The ideal crystalloid solution to be used during the perioperative period in patients undergoing kidney transplantation remains unclear. Normal saline (NS), the intravenous fluid commonly using during the perioperative period, contains a high chloride content, which may be associated with hyperchloremic metabolic acidosis and acute kidney injury. Balanced crystalloid (BC) solutions have a lower chloride content. The purpose of the study was to determine if a BC solution prevents the incidence of hyperchloremia and hyperkalemia during renal transplantation. METHODS: NS and BC given during kidney transplantation are compared. The primary outcome was hyperchloremia and hyperkalemia within 24 hours after surgery. Secondary outcomes were levels of serum creatinine at preoperative and within 5 days after transplantation, the incidence of acute rejection episodes, graft failure, length of stay at hospital, and mortality. RESULTS: A total of 60 patients were included in the study (30 in the BC group and 30 in the NS group). The mean postoperative chloride was 103.0 mmol/L (95% CI, 101-105) in the NS group and 100 mmol/L (95% CI, 98-102) in the BC group (P < .05). There were no significant differences in demographic characteristics, serum creatinine values within 5 days, short-term outcomes, and graft survival rates at 28 days postoperatively between groups (P > .05). CONCLUSIONS: Our results suggest that a moderate volume (approximately 1500.0 mL) of NS infusion causes hyperchloremia rather than adverse clinical outcomes. A moderate amount of NS infusion can be used safely during uncomplicated living-donor kidney transplantations.


Assuntos
Acidose/epidemiologia , Lesão Renal Aguda/epidemiologia , Soluções Cristaloides/efeitos adversos , Hidratação/efeitos adversos , Hiperpotassemia/epidemiologia , Transplante de Rim , Solução Salina/efeitos adversos , Acidose/induzido quimicamente , Lesão Renal Aguda/induzido quimicamente , Adulto , Creatinina/sangue , Feminino , Hidratação/métodos , Humanos , Hiperpotassemia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Período Perioperatório
15.
Medicine (Baltimore) ; 98(33): e16872, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415426

RESUMO

Patients undergoing surgery and taking angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) are susceptible to complications related to intraoperative hypotension. Perioperative continuation of such medications in patients undergoing colorectal surgery may be associated with more harm than benefit, as these patients are often exposed to other risk factors which may contribute to intraoperative hypotension. Our objectives were to assess the incidence and severity of postinduction hypotension as well as the rates of acute kidney injury (AKI), 30-day all-cause mortality, 30-day readmission, and hospital length of stay in adult patients undergoing colorectal surgery who take ACEi/ARB.We performed a retrospective chart review of patients undergoing colorectal surgery of ≥4 hour duration at a tertiary care academic medical center between January 2011 and November 2016. The preoperative and intraoperative characteristics as well as postoperative outcomes were compared between patients taking ACEi/ARB and patients not taking these medications.Of the 1020 patients meeting inclusion criteria, 174 (17%) were taking either ACEi or ARB before surgery. Patients taking these medications were more likely to receive both postinduction and intraoperative phenylephrine and ephedrine. The incidences of postoperative AKI (P = .35), 30-day all-cause mortality (P = .36), 30-day hospital readmission (P = .45), and hospital length of stay (P = .25), were not significantly different between the 2 groups.Our results support the current recommendation that ACEi/ARB use is probably safe within the colorectal surgery population during the perioperative period. Intraoperative hypotension should be expected and treated with vasopressors.


Assuntos
Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Cirurgia Colorretal/efeitos adversos , Hipotensão/induzido quimicamente , Assistência Perioperatória/métodos , Lesão Renal Aguda/induzido quimicamente , Adulto , Estudos de Casos e Controles , Cirurgia Colorretal/mortalidade , Feminino , Humanos , Hipotensão/tratamento farmacológico , Masculino , Estudos Retrospectivos , Vasoconstritores/uso terapêutico
16.
AJR Am J Roentgenol ; 213(4): 728-735, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31386574

RESUMO

OBJECTIVE. Contrast-induced nephropathy (CIN) generally is the main concern for patients with chronic kidney disease (CKD) undergoing contrast-enhanced imaging. To evaluate the risk of nephropathy induced by IV contrast medium (CM) in patients with CKD, we performed a meta-analysis. MATERIALS AND METHODS. We searched for PubMed and MEDLINE articles that were published up to October 3, 2018, contained the phrase "contrast medium" or "contrast media" and the word "renal," and included patients with CKD and a proper control group. The publications that were identified were reviewed, and only studies that used an IV route of CM administration were selected. Subgroup analysis was performed according to the estimated glomerular filtration rate. RESULTS. Six studies including 55,963 participants were selected. The Peto method and random-effects model were applied. IV infusion of CM did not lead to the deterioration of renal function in patients with CKD compared with those without CKD (odds ratio [OR], 1.07; 95% CI, 0.98-1.17; I2, 35.3%). As the estimated glomerular filtration rate decreased, fewer patients received IV CM. The ORs for CIN on the basis of CKD stage were as follows: 1.11 (95% CI, 0.95-1.30; I2, 4.0%) for stage 2 CKD, 1.05 (95% CI, 0.93-1.18, I2, 48.3%) for CKD lower than stage 3, 1.06 (95% CI, 0.94-1.19; I2, 32.0%) for stage 3 CKD, 1.08 (95% CI, 0.84-1.39; I2, 44.6%) for CKD lower than stage 4, 0.86 (95% CI, 0.37-2.00) for stage 4 CKD, and 0.26 (95% CI, 0.02-3.4) for stage 5 CKD in one study only. All analyses showed the lack of difference in the ORs for CIN between participants who received IV injection of CM and those who did not. CONCLUSION. Retrospective cohort studies of IV radiographic CM have failed to show renal damage in patients with CKD. This retrospective study is limited, and other risk factors for CIN might not be distributed evenly.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Insuficiência Renal Crônica/diagnóstico por imagem , Humanos
17.
Medicine (Baltimore) ; 98(32): e16801, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393410

RESUMO

BACKGROUND: Contrast-induced nephropathy (CIN) is acute renal failure observed after administration of iodinated contrast media during angiographic or other medical procedures. In recent years, many studies have focused on biomarkers that recognize CIN and/or predict its development in advance. One of the many biomarkers studied is the platelet-to-lymphocyte ratio (PLR). We performed a systematic review and meta-analysis to evaluate the correlation between PLR level and CIN. METHODS: Relevant studies were searched in PUBMED, EMBASE, and Web of Science until September 15, 2018. Case-control studies reporting admission PLR levels in CIN and non-CIN group in patients with acute coronary syndrome (ACS) were included. The pooled weighted mean difference (WMD) and 95% confidence intervals (95%CI) were calculated to assess the association between PLR level and CIN using a random-effect model. RESULTS: Six relevant studies involving a total of 10452 ACS patients (9720 non-CIN controls and 732 CIN patients) met our inclusion criteria. A meta-analysis of 6 case-control studies showed that PLR levels were significantly higher in CIN group than those in non-CIN group (WMD = 33.343, 95%CI = 18.863 to 47.823, P < .001, I = 88.0%). CONCLUSION: For patients with ACS after contrast administration, our meta-analysis shows that on-admission PLR levels in CIN group are significantly higher than those of non-CIN group. However, large and matched cohort studies are needed to validate these findings and assess whether there is a real connection or just an association.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Lesão Renal Aguda/induzido quimicamente , Plaquetas/metabolismo , Meios de Contraste/efeitos adversos , Linfócitos/metabolismo , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/cirurgia , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Humanos , Contagem de Linfócitos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos
18.
Int Heart J ; 60(5): 1077-1082, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31447466

RESUMO

Patients with ST-segment elevation myocardial infarction (STEMI) who are treated by primary percutaneous coronary intervention (PPCI) have an increased risk of developing contrast-induced nephropathy (CIN) when compared with patients undergoing elective percutaneous coronary intervention (PCI). However, CIN prevention measures are less frequently applied in PPCI than in elective PCI. At present, no preventive strategy has been recommended by the current guidelines for patients with STEMI undergoing PPCI.Published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from 1966 to July 2018. Internet-based sources of information on the results of clinical trials in cardiology were also searched.A total of three randomized trials involving 924 patients were included in the present meta-analysis, of whom 462 received hydration with isotonic saline (hydration group) and 462 received no hydration (control group). Periprocedural hydration with isotonic saline was associated with a significant decrease in the rate of CIN (16.9% in the hydration group versus 26.4% in the control group; summary risk ratio: 0.64, 95% confidence interval: 0.50-0.82, P = 0.0005). There was no difference in the rate of postprocedural hemodialysis or death between the groups.Intravenous saline hydration during PPCI reduced the risk of CIN without significantly altering the rate of requirement for renal replacement therapy or mortality.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/terapia , Meios de Contraste/efeitos adversos , Hidratação/métodos , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Lesão Renal Aguda/prevenção & controle , Idoso , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Papel (figurativo) , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Análise de Sobrevida , Resultado do Tratamento
19.
Internist (Berl) ; 60(9): 996-1003, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31468086

RESUMO

BACKGROUND: Iodinated contrast is essential for diagnosis and treatment in contemporary interventional cardiology. An important complication of percutaneous intervention is contrast-induced nephropathy, which is associated with increased morbidity and mortality, while prolonged hospitalization is responsible for economic consequences. OBJECTIVES: This article reviews the definition of contrast-induced nephropathy, the role of biomarkers in early diagnosis to identify high-risk patients and potential therapeutic options for preventing acute nephropathy. CURRENT DATA: The optimization of patients' circulating volume remains the main aspect for preventing contrast-induced nephropathy, as recent studies confirm. Several medications are known to be nephrotoxic, whereas several are nephroprotective and the subject of recent research. CONCLUSION: Interventions to improve outcomes of established acute kidney injury have not been developed as yet. Prevention and early diagnosis are relevant factors in clinical management. It is important to identify patients at risk and to treat them preemptively.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Biomarcadores , Meios de Contraste/administração & dosagem , Humanos , Intervenção Coronária Percutânea , Fatores de Risco
20.
Am J Health Syst Pharm ; 76(16): 1211-1217, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369116

RESUMO

PURPOSE: Results of a study to determine whether obesity is associated with acute kidney injury (AKI) among patients receiving combination therapy with piperacillin-tazobactam and vancomycin are reported. METHODS: A retrospective, single-center cohort study of patients who received combination therapy for at least 48 hours was conducted using data from the University of Kentucky Center for Clinical and Translational Science's Enterprise Data Trust. Patients with chronic kidney disease, baseline creatinine clearance of less than 30 mL/min, cystic fibrosis, or missing height or weight information were excluded. RESULTS: A total of 8,125 patients were included in the cohort. Among the variables evaluated, total body weight of 91 kg or more was the variable most predictive of AKI. Patients with a weight of 91 kg or higher were more likely than lower-weight patients to have diabetes (39% versus 21%, p < 0.00001), hypertension (64% versus 47%, p < 0.00001), and heart failure (15% versus 13%, p = 0.007). The median daily vancomcyin dose was lower in patients with a weight of less than 91 kg (2,000 mg versus 3,000 mg, p < 0.00001); however, weight-based doses were lower in patients weighing 91 kg or more (25.5 mg/kg/day versus 27.9 mg/kg/day, p < 0.00001). AKI was more common in patients weighing 91 kg or more (24% versus 18%, p < 0.00001; adjusted odds ratio, 1.46 [95% confidence interval, 1.28-1.66]). CONCLUSION: Increased total body weight increased the rate of AKI among patients concurrently treated with piperacillin-tazobactam and vancomycin independent of clinically important confounders, with an important breakpoint occurring at 91 kg.


Assuntos
Lesão Renal Aguda/epidemiologia , Antibacterianos/efeitos adversos , Obesidade/epidemiologia , Combinação Piperacilina e Tazobactam/efeitos adversos , Vancomicina/efeitos adversos , Lesão Renal Aguda/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA