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1.
Life Sci ; 251: 117640, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32259603

RESUMO

AIM: To evaluate the effects of P2X7 receptor blockade on renin-angiotensin system (RAS) in rats with diabetic nephropathy (DN). MAIN METHODS: Wistar rats were unilaterally nephrectomized and received streptozotocin for diabetes mellitus (DM) induction; control animals (CTL) received the drug vehicle. The animals were submitted to P2X7 receptor silencing, forming the group (DM + siRNA). The animals were placed in metabolic cages for data collection and evaluation of renal function; at the end of the protocol, the kidney was removed for analysis of P2X7, renin, angiotensin-converting enzyme (ACE), ACE2, angiotensin, thiobarbituric acid reactive substance levels (TBARS), nitric oxide (NO) and qualitative histological. KEY FINDINGS: The metabolic profile was attenuated in DM + siRNA vs. DM and there was a significant improvement in creatinine, urea and proteinuria levels in the same group. Renin expression was significantly decreased in DM + siRNA vs. DM. ACE and ACE2 were significantly reduced in DM + siRNA vs. DM. TBARS levels were decreased and NO showed an increase in DM + siRNA vs. DM, both significant. All histological alterations were improved in DM + siRNA vs. DM. SIGNIFICANCE: Data have shown that although silencing of the P2X7 receptor did not decrease fasting glucose, it promoted an improvement in the metabolic profile and a significant recovery of renal function, revealing a protective action by the inhibition of this receptor. This effect must have occurred due to the inhibition of RAS and the increase of NO, suggesting that the use of P2X7 receptors inhibitors could be used as adjuvant therapy against DN progression.


Assuntos
Diabetes Mellitus Experimental/terapia , Nefropatias Diabéticas/terapia , Inativação Gênica , Receptores Purinérgicos P2X7/genética , Sistema Renina-Angiotensina/genética , Animais , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/genética , Nefropatias Diabéticas/genética , Nefropatias Diabéticas/fisiopatologia , Masculino , Óxido Nítrico/metabolismo , RNA Interferente Pequeno/administração & dosagem , Ratos , Ratos Wistar , Estreptozocina
2.
Medicine (Baltimore) ; 98(47): e17819, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764774

RESUMO

INTRODUCTION: Diabetic nephropathy (DN) is one of the microvascular complications of diabetes (DM). Proteinuria is the most important clinical feature of DN and an independent risk factor for the progression of DN. Therefore, reducing urinary protein is the primary goal of DN treatment. Acupuncture has long been widely used in the treatment of DN. Therefore, this paper conducted a meta-analysis of the clinical efficacy of acupuncture in the treatment of DN proteinuria, in order to comprehensively analyze the role of acupuncture in the treatment of DN. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019.We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of DN proteinuria. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of acupuncture for DN proteinuria. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019139705.


Assuntos
Terapia por Acupuntura , Nefropatias Diabéticas/terapia , Metanálise como Assunto , Proteinúria/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Nefropatias Diabéticas/complicações , Humanos , Proteinúria/etiologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(47): e17923, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764792

RESUMO

BACKGROUND: This study aims to assess the efficacy and safety of dialysis for the treatment of patients with diabetic nephropathy (DN). METHODS: We will comprehensively retrieve the following databases of Cochrane Library, PUBMED, EMBASE, Global health, CINAHL, PsycINFO, Scopus, CBM, Wangfang, and CNKI for studies related to the topic. We will search all those electronic databases from their inceptions to the present without restrictions of language and publication status. Two authors will independently conduct all procedures of study selection, data collection, and risk of bias assessment. We will apply RevMan 5.3 software for statistical analysis. RESULTS: We will systematically investigate the efficacy and safety of dialysis for DN through assessing primary and secondary outcomes. The primary outcomes include improvement in renal function, as assessed by the urinary albumin/creatinine ratio, estimated glomerular filtration rate, and serum creatinine levels. The secondary outcomes consist of levels of inflammatory markers, endothelial dysfunction markers, quality of life, and any expected and unexpected adverse events. CONCLUSION: This study will present evidence on the efficacy and safety of dialysis for the treatment of patients with DN. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019149699.


Assuntos
Nefropatias Diabéticas/terapia , Diálise Renal , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Humanos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(42): e17618, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626140

RESUMO

OBJECTIVE: To assess the efficacy and safety of the Wenyang Huoxue method for patients with diabetic peripheral neuropathy. METHODS: A systematic literature search was performed using 7 databases: PUBMED, EMBASE, the Chinese National Knowledge Infrastructure, Wanfang, Chinese BioMedical, and the VIP Chinese Science and Technique Journals. The publication time was from the start of each database up to November 2018. Review Manager 5.3 software was used for assessing potential bias, data synthesis, and the subgroup analysis. Begg and Egger tests were used to assess funnel plot symmetries using Stata 14.0 software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. RESULTS: A total of 22 trials involving 1835 participants were eligible. There were significant differences in a total effective rate between the Wenyang Huoxue method combined with Western medicine and Western medicine alone (RR = 1.33, 95% CI 1.26-1.41; P < .00001). As for the sensory conduction velocity (SCV) of the peroneal nerve, the Wenyang Huoxue method combined with Western medicine compared with Western medicine alone had a significant increase (weighted mean difference [WMD] = 5.00, 95% CI 3.42-6.57; P < .00001). Also, the Wenyang Huoxue method combined with Western medicine had significant increases in motor conduction velocity (MCV) of the peroneal nerve (WMD = 4.48, 95% CI 3.78-5.19; P < .00001), tibial nerve SCV (WMD = 3.47, 95% CI 2.66-4.28; P < .00001), tibial nerve MCV (4.87, 95% CI 3.21-6.53; P < .00001), median nerve SCV (WMD = 3.78, 95% CI 3.07-4.50; P < .00001), and median nerve MCV (WMD = 4.50, 95% CI 3.40-5.59; P < .00001). However, the effect of the Wenyang Huoxue method on fasting blood glucose, 2-h postprandial blood glucose, and glycosylated hemoglobin was not statistically significant. Egger's test results showed that there was no publication bias (P = .0008), but the trim and filling method showed steady results. An influence analysis showed that no single study affected the overall result. The GRADE quality of the evidence was low to moderate across the different outcomes. CONCLUSION: Despite of the apparently positive findings, the quality of GRADE is not high, suggesting that the Wenyang Huoxue method can improve nerve conduction velocity to a certain extent, but more rigorous literature is needed to support this evidence.


Assuntos
Nefropatias Diabéticas/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Resultado do Tratamento
5.
Nutr Metab Cardiovasc Dis ; 29(11): 1127-1150, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31586514

RESUMO

AIMS: This joint document of the Italian Diabetes Society and the Italian Society of Nephrology reviews the natural history of diabetic kidney disease (DKD) in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents. DATA SYNTHESIS: Recent epidemiological studies have disclosed a wide heterogeneity of DKD. In addition to the classical albuminuric phenotype, two new albuminuria-independent phenotypes have emerged, i.e., "nonalbuminuric renal impairment" and "progressive renal decline", suggesting that DKD progression toward end-stage kidney disease (ESKD) may occur through two distinct pathways, albuminuric and nonalbuminuric. Several biomarkers have been associated with decline of estimated glomerular filtration rate (eGFR) independent of albuminuria and other clinical variables, thus possibly improving ESKD prediction. However, the pathogenesis and anatomical correlates of these phenotypes are still unclear. Also the management of hyperglycemia in patients with type 2 diabetes and impaired renal function has profoundly changed during the last two decades. New anti-hyperglycemic drugs, which do not cause hypoglycemia and weight gain and, in some cases, seem to provide cardiorenal protection, have become available for treatment of these individuals. In addition, the lowest eGFR safety thresholds for some of the old agents, particularly metformin and insulin secretagogues, have been reconsidered. CONCLUSIONS: The heterogeneity in the clinical presentation and course of DKD has important implications for the diagnosis, prognosis, and possibly treatment of this complication. The therapeutic options for patients with type 2 diabetes and impaired renal function have substantially increased, thus allowing a better management of these individuals.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/terapia , Taxa de Filtração Glomerular , Hipoglicemiantes/uso terapêutico , Falência Renal Crônica/terapia , Rim/fisiopatologia , Biomarcadores/sangue , Glicemia/metabolismo , Tomada de Decisão Clínica , Consenso , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Progressão da Doença , Humanos , Hipoglicemiantes/efeitos adversos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Seleção de Pacientes , Fatores de Risco , Resultado do Tratamento
6.
Pan Afr Med J ; 33: 162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565124

RESUMO

Introduction: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. Methods: Descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. Results: The average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. Conclusion: The practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.


Assuntos
Nefropatias/terapia , Diálise Renal/métodos , Autocuidado/métodos , Adulto , Idoso , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Humanos , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Marrocos , Cooperação do Paciente/estatística & dados numéricos
8.
Acta Diabetol ; 56(12): 1323-1331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494747

RESUMO

AIMS: Nephropathic patients show higher levels of advanced glycation end products (AGEs) and oxidized human serum albumin (HSAox) compared to healthy subjects. These two classes of compounds are formed as the result of oxidative insults; for this reason, they can be useful oxidative stress biomarkers. The present study examines the variation of AGEs and HSAox in hemodialysis (HD) patients before and after dialysis session, evaluating the impact of different dialytic techniques and filters on their removal. METHODS: A total of 50 healthy subjects (control group) and 130 HD patients were enrolled in the study. Hemodialysis patients were subdivided based on dialytic techniques: 109 in diffusive technique and 22 in convective technique. We monitored HSAox, AGEs and other laboratory parameters at early morning in healthy subjects and in HD patients before and after the dialysis procedures. RESULTS: The level of HSAox decreases after a single dialytic session (from 58.5 ± 8.8% to 41.5 ± 11.1%), but the concentration of total AGEs increases regardless of adopted dialytic techniques (from 6.8 ± 5.2 µg/ml to 9.2 ± 4.4 µg/ml). In our study, levels of HSAox and total AGEs are similar in diabetic and non-diabetic HD patients. The increase in total AGEs after dialysis was only observed using polysulfone filters but was absent with polymethacrylate filters. CONCLUSIONS: HSAox is a simple and immediate method to verify the beneficial effect of a single dialysis session on the redox imbalance, always present in HD patients. Total AGEs assayed by ELISA procedure seem to be a less reliable biomarker in this population.


Assuntos
Biomarcadores , Produtos Finais de Glicação Avançada/sangue , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Albumina Sérica Humana/metabolismo , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Casos e Controles , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Produtos Finais de Glicação Avançada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Oxirredução , Estresse Oxidativo/fisiologia , Polímeros/química , Ácidos Polimetacrílicos/química , Prognóstico , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Albumina Sérica Humana/análise , Sulfonas/química , Resultado do Tratamento
9.
J. bras. nefrol ; 41(3): 315-322, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040245

RESUMO

Abstract Introduction: It is hypothesized that increased macrophage migration inhibitory factor (MIF) expression may contribute to diabetic nephropathy (DN) pathogenesis. The aim of the present study was to investigate the renal effects of MIF inhibition in a diabetic experimental model. Methods: Eighteen male Wistar rats (230 ± 20 g) were divided into three groups: 1) control, 2) diabetic (STZ, 50 mg/kg, dissolved in saline, ip), 3) diabetic + MIF antagonist (p425, 1 mg/kg per day, ip, on the 21th day, for 21 consecutive days). The treatment started since we founwd a significant increase in urine albumin excretion (UAE) rate in the diabetic rats in comparison with the control rats. The rats were kept individually in metabolic cages (8 AM-2 PM) and urine samples were collected in the 21 and 42th day. At the end, blood and tissue samples were collected for biochemical (BS, UPE, urine GAG, BUN, Cr, Na, and K) and histological analyses. Results: The results of this study showed that MIF antagonist (p425) significantly decreased urine protein and GAG excretion, urine protein/creatinine ratio, and serum BUN and Cr in the streptozotocin-induced DN in the rats. Pathological changes were significantly alleviated in the MIF antagonist (p425)-administered DN rats. Conclusion: Collectively, these data suggested that MIF antagonist (p425) was able to protect against functional and histopathological injury in the DN.


Resumo Introdução: Supõe-se que elevações da expressão do fator de inibição da migração de macrófagos (MIF) possam contribuir para a patogênese da nefropatia diabética (ND). O objetivo do presente estudo foi investigar os efeitos renais da inibição do MIF em um modelo experimental diabético. Métodos: Dezoito ratos Wistar machos (230 ± 20g) foram divididos em três grupos: 1) controle, 2) diabético (STZ 50 mg/kg dissolvida em soro fisiológico, IP), 3) diabético + antagonista do MIF (p425 1 mg/kg por dia IP no 21o dia por 21 dias consecutivos). O tratamento começou após a identificação de aumento significativo na albuminúria nos ratos diabéticos em relação aos controles. Os ratos foram mantidos individualmente em gaiolas metabólicas (8h-14h) e amostras de urina foram colhidas no 21o e no 42o dia. Ao final do estudo, amostras de sangue e tecido foram colhidas para análises bioquímicas (BS, excreção urinária de proteína, excreção urinária de GAGs, BUN, Cr, Na e K) e histológicas. Resultados: O presente estudo demonstrou que o antagonista do MIF (p425) diminuiu significativamente proteinúria, excreção urinária de GAGs , relação proteína/creatinina na urina, BUN e Cr no grupo com ND induzida por estreptozotocina. As alterações patológicas foram significativamente abrandadas nos ratos com ND que receberam antagonista do MIF (p425). Conclusão: Coletivamente, os dados sugerem que o antagonista do MIF (p425) teve efeito protetor contra lesões funcionais e histopatológicas da ND.


Assuntos
Animais , Masculino , Ratos , Fatores Inibidores da Migração de Macrófagos/antagonistas & inibidores , Oxirredutases Intramoleculares/antagonistas & inibidores , Substâncias Protetoras/uso terapêutico , Substâncias Protetoras/farmacologia , Diabetes Mellitus Experimental/patologia , Nefropatias Diabéticas/terapia , Glicemia , Ratos Wistar , Estreptozocina/farmacologia , Creatinina/urina , Creatinina/sangue , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/urina , Diabetes Mellitus Experimental/sangue , Nefropatias Diabéticas/urina , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/sangue , Albuminúria/tratamento farmacológico , Modelos Animais de Doenças , Glicosaminoglicanos/urina , Rim/patologia , Ativação de Macrófagos
10.
Prog Cardiovasc Dis ; 62(4): 298-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31377223

RESUMO

The prevalence of Type 2 diabetes mellitus (T2DM) has reached pandemic proportions. T2DM frequently causes macrovascular and/or microvascular pathologic changes and thereby increases the risks for the development of myocardial infarction, heart failure, stroke, renal failure, and reduced survival. This article describes the important interactions between T2DM, heart failure, and renal dysfunction, forming vicious circles. The interruption of these circles represents important therapeutic goals.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Cardiomiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Comorbidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Cardiomiopatias Diabéticas/diagnóstico , Cardiomiopatias Diabéticas/terapia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/terapia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Masculino , Prevalência , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Índice de Gravidade de Doença , Análise de Sobrevida , Estados Unidos/epidemiologia
11.
Int J Mol Sci ; 20(14)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295940

RESUMO

Diabetic kidney disease (DKD) remains the leading cause of end-stage renal disease (ESRD) and is therefore a major burden on the healthcare system. Patients with DKD are highly susceptible to developing cardiovascular disease, which contributes to increased morbidity and mortality rates. While progress has been made to inhibit the acceleration of DKD, current standards of care reduce but do not eliminate the risk of DKD. There is growing appreciation for the role of inflammation in modulating the process of DKD. The focus of this review is on providing an overview of the current status of knowledge regarding the pathologic roles of inflammation in the development of DKD. Finally, we summarize recent therapeutic advances to prevent DKD, with a focus on the anti-inflammatory effects of newly developed agents.


Assuntos
Nefropatias Diabéticas/etiologia , Suscetibilidade a Doenças , Inflamação/complicações , Animais , Biomarcadores , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/prevenção & controle , Nefropatias Diabéticas/terapia , Humanos , Mediadores da Inflamação/metabolismo , Transdução de Sinais
12.
Medicine (Baltimore) ; 98(27): e16333, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277183

RESUMO

The prognostic utility of histologic features in patients with diabetic nephropathy (DN) classified according to the Renal Pathology Society (RPS) classification is controversial. Therefore, we aimed to evaluate the relationship between histologic changes and renal outcome in DN patients.We examined the renal outcome at November 30, 2017 of 74 adult patients (median age of 54.6 years, 69% male, 81% diabetes mellitus (DM) type 2, estimated GFR (eGFR) 29.6 mL/min) with biopsy proven DN between 2010 and 2015. The primary endpoint was renal replacement therapy (RRT) initiation.Half of the patients progressed to end stage renal disease (ESRD) during follow-up; they had lower eGFR, increased proteinuria, hematuria and serum cholesterol. Regarding the pathologic features, they were more frequently in class III and IV, had higher interstitial fibrosis and tubular atrophy score (IFTA), increased interstitial inflammation, more frequent arteriolar hyalinosis and higher glomerular basement membrane (GBM) thickness. The mean kidney survival time was 2.7 (95%CI 2.1, 3.3) years. In univariate time-dependent analyses, higher RPS DN class, increased IFTA, the presence of arteriolar hyalinosis and arteriosclerosis were associated with RRT initiation.In the fully adjusted model, the clinical characteristics associated with poor renal survival were longer duration of DM, lower eGFR, increased proteinuria and higher hematuria and the only pathologic lesions to remain significant were the GBM thickness and the IFTA.In conclusion, in this European cohort, the severity of glomerular lesions evaluated with the RPS DN classification had limited utility in predicting RRT initiation. However, IFTA and GBM thickness were significantly associated with renal survival.


Assuntos
Nefropatias Diabéticas/patologia , Falência Renal Crônica/etiologia , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/terapia , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Terapia de Substituição Renal , Estudos Retrospectivos , Taxa de Sobrevida
13.
Oxid Med Cell Longev ; 2019: 8259645, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31354913

RESUMO

Background: Diabetic nephropathy is the most common cause of end-stage renal disease. Traditional therapy for diabetic nephropathy has focused on supportive treatment, and there is no significant effective therapy. We investigated the effect of low-energy extracorporeal shock wave therapy on a diabetic nephropathy rat model. Methods: Streptozotocin-induced diabetic nephropathy rats were treated with six sessions of low-energy extracorporeal shock wave therapy (weekly for six consecutive weeks) or left untreated. We assessed urinary creatinine and albumin, glomerular volume, renal fibrosis, podocyte number, renal inflammation, oxidative stress, and tissue repair markers (SDF-1 and VEGF) six weeks after the completion of treatment. Results: The six-week low-energy extracorporeal shock wave therapy regimen decreased urinary albumin excretion as well as reduced glomerular hypertrophy and renal fibrosis in the rat model of diabetic nephropathy. Moreover, low-energy extracorporeal shock wave therapy increased podocyte number in diabetic nephropathy rats. This was likely primarily attributed to the fact that low-energy extracorporeal shock wave therapy reduced renal inflammation and oxidative stress as well as increased tissue repair potency and cell proliferation. Conclusions: Low-energy extracorporeal shock wave therapy preserved kidney function in diabetic nephropathy. Low-energy extracorporeal shock wave therapy may serve as a novel noninvasive and effective treatment of diabetic nephropathy.


Assuntos
Nefropatias Diabéticas/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Rim/patologia , Animais , Nefropatias Diabéticas/patologia , Modelos Animais de Doenças , Masculino , Ratos , Ratos Wistar
14.
Tohoku J Exp Med ; 248(2): 125-135, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243243

RESUMO

Intervention for higher-risk participants of health checkups especially with diabetes has been started in Japan to prevent renal replacement therapy (RRT) initiation, but evidence about RRT initiation risk among checkup participants has been scarce. To estimate the incidence by risk factors, we conducted a retrospective cohort study using medical claims and checkup data of a community-based insurance scheme in Japan. Beneficiaries who participated in the checkup in 2012-2013 were included and followed up for about five years. We estimated the incidence of RRT initiation by the subject characteristics, followed by investigation for risk factors in bivariate analyses and multivariable regression analyses with Bayesian prior probability distributions. As a result, among 49,252 participants, 37 initiated dialysis (0.21/1,000 person-years); no kidney transplantation was performed during the period. Baseline estimated glomerular filtration rate was strongly associated with dialysis initiation. No dialysis was initiated among those without baseline hypertension; cumulative incidence by hypertension status was significantly different (p < 0.001). Diabetes was significantly associated with dialysis initiation in bivariate analysis, but the association was not significant in multivariable regression analysis [reference: no diabetes; incidence rate ratio (IRR) for diabetes without medication, 3.30 (95% credible interval, 0.48-15.56); IRR for diabetes with medication, 1.69 (95% credible interval, 0.68-3.47)]. In conclusion, potential risk factors for RRT initiation include male sex, comorbid hypertension, and current smoking status, in addition to advanced chronic kidney disease, proteinuria, and diabetes. New initiatives should consider these factors to increase the efficacy of the programs at the population level.


Assuntos
Seguro , Terapia de Substituição Renal , Medição de Risco , Adulto , Idoso , Nefropatias Diabéticas/terapia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Insuficiência Renal Crônica/terapia
15.
Ren Fail ; 41(1): 521-531, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216914

RESUMO

Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD. Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model. Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10-1.30; I2 = 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient = 0.270, SE = 0.112, p = .033). Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings. Conclusion: ESRD patients with diabetes may benefit more from HD than PD.


Assuntos
Nefropatias Diabéticas/terapia , Falência Renal Crônica/terapia , Diálise Peritoneal , Diálise Renal , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/patologia , Progressão da Doença , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/patologia , Resultado do Tratamento
16.
J. bras. nefrol ; 41(2): 208-214, Apr.-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1012536

RESUMO

Abstract Introduction: Having national data on chronic dialysis is essential in treatment planning. Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.


Resumo Introdução: Dados nacionais sobre diálise crônica são fundamentais no planejamento do tratamento. Objetivo: Apresentar dados do inquérito da Sociedade Brasileira de Nefrologia sobre os pacientes com doença renal crônica em tratamento dialítico em julho de 2017. Métodos: Levantamento de dados de unidades de diálise do país. A coleta de dados foi feita utilizando questionário preenchido on-line pelas unidades de diálise. Resultados: 291 (38,4%) centros responderam ao questionário. Em julho de 2017, o número total estimado de pacientes em diálise foi de 126.583. As estimativas nacionais das taxas de prevalência e de incidência de pacientes em tratamento dialítico por milhão da população (pmp) foram 610 (variação: 473 na região Norte e 710 no Centro-Oeste) e 194, respectivamente. A taxa de incidência de novos pacientes em diálise com diagnóstico de nefropatia diabética foi de 77 pmp. A taxa anual de mortalidade bruta foi de 19,9%. Dos pacientes prevalentes, 93,1% estavam em hemodiálise e 6,9% em diálise peritoneal, com 31.226 (24%) em fila de espera para transplante. Cateter venoso era usado como acesso em 22,6% dos pacientes em hemodiálise. A taxa de prevalência de sorologia positiva para hepatite C continua a mostrar tendência para redução (3,3%). Conclusão: O número absoluto de pacientes e as taxas de incidência e prevalência em diálise continuam a aumentar; a taxa de mortalidade tendeu a elevar-se. Há discrepâncias regionais e estaduais evidentes nessas taxas.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Inquéritos e Questionários , Diálise Peritoneal , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Brasil/epidemiologia , Incidência , Prevalência , Mortalidade/tendências , Transplante de Rim , Nefropatias Diabéticas/terapia , Nefropatias Diabéticas/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-31122756

RESUMO

Twenty-three percent of women with known chronic kidney disease (CKD) have been reported to demonstrate the first decline in kidney function between giving birth and six-weeks postpartum. As such, these women warrant close monitoring during the postpartum period irrespective of their pregnancy journey. Substantial haemodynamic variability during pregnancy and postpartum renders estimated glomerular filtration rate inaccurate, and poorly defined normal ranges of markers of kidney function at this time pose challenges for accurate assessment of renal complications. Multi-disciplinary specialist care is therefore essential, with consideration of specific implications of any known renal diagnosis and with observation for the development of postpartum complications of pregnancy. Furthermore, the postpartum period affords time to further investigate and diagnose kidney disease revealed by pregnancy. Good care planning and communication in the postpartum period has the potential to improve long-term health outcomes for women with known or new CKD and will be discussed in this review.


Assuntos
Nefrite Lúpica/tratamento farmacológico , Cuidado Pós-Natal , Complicações na Gravidez/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Nefropatias Diabéticas/terapia , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Gravidez , Proteinúria/etiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Microangiopatias Trombóticas/tratamento farmacológico
19.
Int J Mol Sci ; 20(10)2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31109047

RESUMO

Mesenchymal stem cells constitute a pool of cells present throughout the lifetime in numerous niches, characteristic of unlimited replication potential and the ability to differentiate into mature cells of mesodermal tissues in vitro. The therapeutic potential of these cells is, however, primarily associated with their capabilities of inhibiting inflammation and initiating tissue regeneration. Owing to these properties, mesenchymal stem cells (derived from the bone marrow, subcutaneous adipose tissue, and increasingly urine) are the subject of research in the settings of kidney diseases in which inflammation plays the key role. The most advanced studies, with the first clinical trials, apply to ischemic acute kidney injury, renal transplantation, lupus and diabetic nephropathies, in which beneficial clinical effects of cells themselves, as well as their culture medium, were observed. The study findings imply that mesenchymal stem cells act predominantly through secreted factors, including, above all, microRNAs contained within extracellular vesicles. Research over the coming years will focus on this secretome as a possible therapeutic agent void of the potential carcinogenicity of the cells.


Assuntos
Nefropatias/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Animais , Células da Medula Óssea/citologia , Células da Medula Óssea/metabolismo , Diferenciação Celular , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/terapia , Exossomos/metabolismo , Vesículas Extracelulares/metabolismo , Glomerulonefrite/etiologia , Glomerulonefrite/metabolismo , Glomerulonefrite/terapia , Humanos , Imunomodulação , Nefropatias/etiologia , Nefropatias/metabolismo , MicroRNAs/genética , Interferência de RNA , Regeneração , Pesquisa
20.
Exp Clin Transplant ; 17(2): 138-146, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30945628

RESUMO

Diabetic nephropathy is one of the main long-term diabetic microangiopathies that can complicate type 1 and 2 and other secondary forms of diabetes mellitus, including posttransplant diabetes mellitus. Posttransplant diabetes mellitus was initially reported in the 1960s, with case reports of recurrent and de novo diabetic nephropathy after kidney transplant reported in the early 2000s, mostly as a result of same-risk and precipitating factors of diabetic nephropathy as in native kidneys. The disease may appear early in view of the hyperfiltration risk of being a single grafted kidney. Here, we discuss risk factors, early serologic and genetic biomarkers for early detection, and strategies to avoid and delay the progression of diabetic nephropathy after posttransplant diabetes mellitus. In this overview of published literatures, we searched PubMed and MEDLINE for all articles published in English language between January 1994 and July 2018. Included studies reported on the prevalence, incidence, or determinants of post-transplant diabetes among renal transplant recipients and studies reporting diabetic nephropathy in their cohorts. Our review showed that avoidance or good control of posttransplant diabetes is the cornerstone in management of posttransplant diabetes mellitus and hence diabetic nephropathy. Control and avoidance can be commenced in the preparatory stage before transplant using validated genetic markers that can predict posttransplant diabetes mellitus. The use of well-matched donors with tailored immunosuppression (using less diabetogenic agents and possibly steroid-free regimens) and lifestyle modifications are the best preventative strategies. Tight glycemic control, early introduction of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and possibly conversion to less diabetogenic regimens can help to delay progression of diabetic nephropathy.


Assuntos
Diabetes Mellitus/terapia , Nefropatias Diabéticas/terapia , Transplante de Rim/efeitos adversos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Progressão da Doença , Diagnóstico Precoce , Humanos , Imunossupressores/efeitos adversos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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